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Sample records for bronchoscopic lung volume

  1. Bronchoscopic lung volume reduction

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    M. I. Polkey

    2006-12-01

    Full Text Available Surgical lung volume reduction can improve exercise performance and forced expiratory volume in one second in patients with emphysema. However, the procedure is associated with a 5% mortality rate and a nonresponse rate of 25%. Accordingly, interest has focused on alternative ways of reducing lung volume. Two principle approaches are used: collapse of the diseased area using blockers placed endobronchially and the creation of extrapulmonary pathways. Preliminary data from the former approach suggest that it can be successful and that the magnitude of success is related to reduction in dynamic hyperinflation.

  2. Efficacy of bronchoscopic lung volume reduction: a meta-analysis

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    Iftikhar IH

    2014-05-01

    Full Text Available Imran H Iftikhar,1 Franklin R McGuire,1 Ali I Musani21Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of South Carolina, Columbia, SC, USA; 2Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USABackground: Over the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods.Methods: Eligible studies were retrieved from PubMed and Embase for the following BLVR methods: one-way valves, sealants (BioLVR, LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George's Respiratory Questionnaire. Secondary outcomes included treatment-related complications.Results: Except for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001; in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01; and in St George's Respiratory Questionnaire was −8.88 points (95% CI: −12.12 to −5.64; P<0.001.Conclusion: The preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninferiority, if not equivalence, when compared to what is known for surgical LVR.Keyword: emphysema, endobronchial valves, sealants, stents, coils

  3. Treatment of emphysema using bronchoscopic lung volume reduction coil technology : an update on efficacy and safety

    NARCIS (Netherlands)

    Hartman, Jorine E.; Klooster, Karin; ten Hacken, Nick H. T.; Slebos, Dirk-Jan

    2015-01-01

    In the last decade several promising bronchoscopic lung volume reduction (BLVR) treatments were developed and investigated. One of these treatments is BLVR treatment with coils. The advantage of this specific treatment is that it works independently of collateral flow, and also shows promise for pat

  4. Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report.

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    Pato, O; Rama, P; Allegue, M; Fernández, R; González, D; Borro, J M

    2010-06-01

    After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.

  5. [Bronchoscopic lung volume reduction is a treatment offered to patients with severe heterogenous emphysema].

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    Perch, Michael; Titlestad, Ingrid L; Rychwicha-Kielek, Beata A; Bendstrup, Elisabeth; Iversen, Martin; Siemsen, Mette; Jørgensen, Ole D; Haahr, Poul Erik

    2014-07-14

    Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been defined as an area of development by The Danish Health and Medicines Authority. We here present the rationale for treatment, in- and exclusion criteria, and ultimately the organization for assessment, treatment and follow-up in Denmark. The treatment aim is to lower dyspnoea. There is a national protocol for patient selection according to in- and exclusion criteria. Different commercial devices are available, but endobronchial valves have been the devices mostly applied. A national database has been established to evaluate cost-effectiveness.

  6. Interventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.

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    Miller, Russell J; Murgu, Septimiu D

    2014-12-01

    Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. LVRS is seldom performed, however, due to the high morbidity associated with the surgery. Numerous bronchoscopic interventions have been introduced with the goal of providing the clinical benefits of LVRS without the surgical complications. Thus far, these modalities have not produced the results once hoped. However, through active modification of both technique and patient selection, the role of minimally invasive modalities in the treatment of emphysema continues to evolve. Bronchial thermoplasty (BT) is a method of delivering controlled heat to airway mucosa with the goal of reducing airway smooth muscle mass and hence bronchoconstriction. In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.

  7. Poor man medical pneumoplasty: Bronchoscopic lung volume reduction with hot saline versus dissolved doxycycline as a neoteric remedy of pulmonary emphysema

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    A.M. Abumossalam

    2016-01-01

    Conclusion: Bronchoscopic lung volume reduction by hot saline and dissolved doxycycline comes into sight to be a safe and feasible profile with an acceptable outcome that presents an attractive substitute to COPD patients who are physiologically friable.

  8. Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

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    Slebos, Dirk-Jan; Klooster, Karin; Ernst, Armin; Herth, Felix J. F.; Kerstjens, Huib A. M.

    2012-01-01

    Background: The lung volume reduction coil (LVR-coil), a new experimental device to achieve lung volume reduction by bronchoscopy in patients with severe emphysema, works in a manner unaffected by collateral airflow. We investigated the safety and efficacy of LVR-coil treatment in patients with hete

  9. Effectiveness of bronchoscopic lung volume reduction using unilateral endobronchial valve: a systematic review and meta-analysis

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    Choi M

    2015-03-01

    Full Text Available Miyoung Choi,1 Worl Suk Lee,1 Min Lee,1 Kyeongman Jeon,2 Seungsoo Sheen,3 Sanghoon Jheon,4 Young Sam Kim5 1National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea; 4Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; 5Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Background: Bronchoscopic lung volume reduction (BLVR can be suggested as an alternative for surgical lung volume reduction surgery for severe emphysema patients. This article intends to evaluate by systematic review the safety and effectiveness of BLVR using a one-way endobronchial valve.Methods: A systematic search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases up to December 2013, was performed. Two reviewers independently screened all references according to selection criteria. The Scottish Intercollegiate Guidelines Network criterion was used to assess quality of literature. Data from randomized controlled trials were combined and meta-analysis was performed. Results: This review included 15 studies. Forced expiratory volume in 1 second (FEV1 improved in the intervention group compared with the control group (mean difference [MD]=6.71, 95% confidence interval [CI]: 3.31–10.11. Six-minute walking distance (MD=15.66, 95% CI: 1.69–29.64 and cycle workload (MD=4.43, 95% CI: 1.80–7.07 also improved. In addition, St George’s Respiratory Questionnaire score decreased (MD=4.29, 95% CI: -6.87 to -1.71 in the intervention group

  10. Efficacy of bronchoscopic lung volume reduction: a meta-analysis [Corrigendum

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    Iftikhar IH

    2014-06-01

    Full Text Available Iftikhar IH, McGuire FR, Musani AI. Int J Chron Obstruct Pulmon Dis. 2014;9:481–491.The authors would like to make a correction to the Disclosure statement. The corrected statement is as follows:IHI and FRM report no potential conflicts of interest with any companies/organizations whose products or services may be discussed in this article. AIM was/is an investigator on the Spiration pivotal study (co-principal investigator, Aeris trial (principal investigator, EASE trial (principal investigator. None of the authors report any funding source for this work.The authors would also like to inform the readers that the first line of the paragraph under the sub-heading “Search strategy and selection criteria”, on page 482 should read as:We searched PubMed and Embase databases from their inception to June 6, 2013 (the search for one way valves and BTVA ended by June 6, 2013, and the search for lung sealants/BioLVR and LVRC/Coils ended by April 30, 2013.Read the original article

  11. Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report

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    Park TS

    2015-07-01

    Full Text Available Tai Sun Park,1 Yoonki Hong,2 Jae Seung Lee,1 Sang Young Oh,3 Sang Min Lee,3 Namkug Kim,3 Joon Beom Seo,3 Yeon-Mok Oh,1 Sang-Do Lee,1 Sei Won Lee1 1Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 2Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea; 3Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Purpose: Endobronchial valve (EBV therapy is increasingly being seen as a therapeutic option for advanced emphysema, but its clinical utility in Asian populations, who may have different phenotypes to other ethnic populations, has not been assessed.Patients and methods: This prospective open-label single-arm clinical trial examined the clinical efficacy and the safety of EBV in 43 consecutive patients (mean age 68.4±7.5, forced expiratory volume in 1 second [FEV1] 24.5%±10.7% predicted, residual volume 208.7%±47.9% predicted with severe emphysema with complete fissure and no collateral ventilation in a tertiary referral hospital in Korea.Results: Compared to baseline, the patients exhibited significant improvements 6 months after EBV therapy in terms of FEV1 (from 0.68±0.26 L to 0.92±0.40 L; P<0.001, 6-minute walk distance (from 233.5±114.8 m to 299.6±87.5 m; P=0.012, modified Medical Research Council dyspnea scale (from 3.7±0.6 to 2.4±1.2; P<0.001, and St George’s Respiratory Questionnaire (from 65.59±13.07 to 53.76±11.40; P=0.028. Nine patients (20.9% had a tuberculosis scar, but these scars did not affect target lobe volume reduction or pneumothorax frequency. Thirteen patients had adverse events, ten (23.3% developed pneumothorax, which included one death due to tension pneumothorax.Conclusion: EBV therapy was as effective and safe in Korean

  12. A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers

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    Luo, Xiongbiao, E-mail: xiongbiao.luo@gmail.com [Robarts Research Institute, Western University, London, Ontario N6A 5K8 (Canada)

    2014-06-15

    Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min{sup −1}. The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An

  13. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease.

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    Jonathan A Kropski

    Full Text Available BACKGROUND: Although in some cases clinical and radiographic features may be sufficient to establish a diagnosis of diffuse parenchymal lung disease (DPLD, surgical lung biopsy is frequently required. Recently a new technique for bronchoscopic lung biopsy has been developed using flexible cryo-probes. In this study we describe our clinical experience using bronchoscopic cryobiopsy for diagnosis of diffuse lung disease. METHODS: A retrospective study of subjects who had undergone bronchoscopic cryobiopsy for evaluation of DPLD at an academic tertiary care center from January 1, 2012 through January 15, 2013 was performed. The procedure was performed using a flexible bronchoscope to acquire biopsies of lung parenchyma. H&E stained biopsies were reviewed by an expert lung pathologist. RESULTS: Twenty-five eligible subjects were identified. With a mean area of 64.2 mm(2, cryobiopsies were larger than that typically encountered with traditional transbronchial forceps biopsy. In 19 of the 25 subjects, a specific diagnosis was obtained. In one additional subject, biopsies demonstrating normal parenchyma were felt sufficient to exclude diffuse lung disease as a cause of dyspnea. The overall diagnostic yield of bronchoscopic cryobiopsy was 80% (20/25. The most frequent diagnosis was usual interstitial pneumonia (UIP (n = 7. Three of the 25 subjects ultimately required surgical lung biopsy. There were no significant complications. CONCLUSION: In patients with suspected diffuse parenchymal lung disease, bronchoscopic cryobiopsy is a promising and minimally invasive approach to obtain lung tissue with high diagnostic yield.

  14. Whole lung lavage in comparison with bronchoscopic lobar lavage using the rigid bronchoscope in patients with pulmonary alveolar proteinosis: Is it time to change strategy?

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    Hesham Alkady

    2016-12-01

    Conclusion: Whole-lung lavage is more efficient than bronchoscopic lobar lavage in treating PAP as it provides larger lavage volumes in shorter time periods and is also associated with lower rate of recurrence of symptoms and the need of relavage.

  15. Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients.

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    Wong, Jackson Y; Westall, Glen P; Snell, Gregory I

    2015-12-01

    Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting.

  16. Fluorescence bronchoscope for lung tumor localization

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    Profio, A.E. (Univ. of California, Santa Barbara); Doiron, D.R.; Huth, G.C.

    1977-02-01

    A fluorescence bronchoscope has been developed for localization of small bronchogenic tumors at the carcinoma in situ stage. Injected hematoporphyrin-derivative is preferentially taken up or retained by a malignant tumor, and very small amounts can be detected by the red fluorescence under excitation by violet light. The target lesion is 80 ..mu..m thick, with a mass of 250 ..mu..g, containing 250 pg of hematoporphyrin-derivative. A fiberoptic bronchoscope system with a 200W high pressure mercury arc lamp, primary filter passing 405 nm light, special violet transmitting light conductor, coherent imaging bundle, red secondary filter, and three-stage electrostatic focus image intensifier tube was designed for this application. Tumors have been visualized in animals and preparations for clinical use are underway.

  17. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema : A Prospective Feasibility Trial

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    Klooster, Karin; ten Hacken, Nick H. T.; Franz, Ina; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction (LVR) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic LVR coil treatment has been shown to

  18. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema: A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, K.; Hacken, N. Ten; Franz, I.; Kerstjens, H.; Rikxoort, E.M. van; Slebos, D.J.

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction ({LVR}) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic {LVR} coil treatment has been show

  19. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema : A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, Karin; ten Hacken, Nick H. T.; Franz, Ina; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction (LVR) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic LVR coil treatment has been shown to

  20. Advances research on bronchoscopic lung volume reduction surgery for obstructive airway diseases%内科肺减容术在慢性阻塞性肺疾病最新研究进展

    Institute of Scientific and Technical Information of China (English)

    谢栓栓; 王昌惠

    2013-01-01

    阻塞性呼吸道疾病是多种疾病组成的,但它们都可因炎症导致气道狭窄,从而导致呼吸做功增加.由于其患病人数多,病死率高,严重影响患者的劳动能力和生活质量.不同群体的哮喘、慢性支气管炎和肺气肿最佳治疗策略应该是多方面的,如高危肺气肿患者应包括药物学和非药物方法以及手术治疗.回顾当前支气管镜介入水平,近十年其发展目标是更好地控制哮喘症状和缓解由于不适合肺减容手术的肺气肿患者症状,由此可见,新型支气管镜技术针对气道阻塞性疾病治疗有很大帮助.%Obstructivepulmonary disease is composed of a variety of diseases,nevertheless,they are able to induce the airway narrow and result in increase of work of breathing force.The incidence and mortality are high,which seriously influence the patients' ability to work and quality of life.There are many optimal treatment strategies of asthma,chronic bronchitis,and emphysema in different groups,such as pharmacological and non-pharmacological methods as well as surgery for high-risk patients with emphysema.In recent decades,the development objective of bronchoscopic intervention is to better control asthma symptoms and relieve symptoms of patients with emphysema who are not suitable for the lung volume reduction surgery.This demonstrates that new bronchoscopic techniques will be helpful for treatment of airway obstruction disease in future.

  1. DETECTION OF p53 GENE MUTATION OF BRONCHOSCOPIC SAMPLIES IN THE PATIENTS SUSPECTED TO LUNG CANCER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To determine the feasibility of detecting p53 gene mutations for early diagnosis of lung cancer using the samples from bronchoscopic examination. Methods: Point mutations of the exon 5-8 of p53 gene were detected in 85 bronchoscopic samples of 35 patients suspected to be lung cancer using silver staining PCR-SSCP. Results: p53 gene mutations were founded in 10 of 35 patients(28.6%). The incidence of p53 gene mutations (14.9%) was obviously higher than the cytological positive incidence(2.9%) in samples of sputum, bronchoalveolar lavage and brush, especially for the sputum(27.7%). In the bronchoscopic biopsy specimens, the incidence of p53 gene mutations (12.5%) was lower than that of pathologic positive result (50.0%). However, in view of all the bronchoscopic samples, there was no statistically difference between cytopathologic positive results (11.8%) and the incidence of p53 gene mutations (14.1%). Although the p53 mutations were most common in the samples from the patients bronchoscopically manifested as neoplasm compared with other manifestations, there was no statistical difference. It is valuable to notice that 3 patients with p53 gene mutation merely presented as bronchial inflammation in bronchoscope. Conclusion: Results indicated that the value of detecting p53 gene mutation for the diagnosis of lung cancer using the bronchoscopic samples was more superior to cytological examination and detection of p53 gene mutations in post-bronchoscopic sputum was easy and effective, may be used as a valuable method for early diagnosis of lung cancer.

  2. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

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    K Rennis Davis

    2015-01-01

    Full Text Available Pulmonary alveolar proteinosis (PAP is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  3. Sequential unilateral lung volume reduction for emphysema - Stretching the benefit.

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    Khorramnia, Sadie; Holsworth, Lynda; Mestitz, Hugh; Westall, Glen P; Williams, Trevor J; Gooi, Julian H; Snell, Gregory I

    2017-01-01

    Bronchoscopic Lung Volume Reduction (BLVR) and Surgical Lung Volume Reduction (SLVR) and are two different approaches used to remodel severely emphysematous lungs to improve lung function and quality-of-life. We present a case initially referred for lung transplantation, where sequential left upper lobe BLVR and 7 years later right upper lobe SLVR, providing enduring physiological and functional improvement. The potential for sustained benefit via sequential unilateral lung volume reduction is under-appreciated.

  4. Laser fluorescence bronchoscope for localization of occult lung tumors

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    Profio, A.E.; Doiron, D.R.; King, E.G.

    1979-11-01

    A system for imaging occult bronchogenic carcinoma by the fluorescence of previously-injected, tumor-specific compound hematoporphyrin-derivative has been assembled and successfully used to locate a tumor l mm thick. The violet excitation source is a krypton ion laser coupled to fused quartz fiber light conductor. An electrostatic image intensifier attached to a standard flexible fiberoptic bronchoscope provides a bright image even at relatively low irradiance. A red secondary filter rejects most reflected background and autofluorescence. Sensitivity and contrast capability of the system should permit detection of a tumor less than 0.1 mm thick.

  5. Bronchoscopic biopsy for diagnosis of lung cancer in the absence of visible endobronchial abnormalities

    Institute of Scientific and Technical Information of China (English)

    Hua Zheng; Baohua Lu; Qunhui Wang Co-first author; Fanbin Hu; Weimin Ding; Baolan Li

    2016-01-01

    Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par-ticularly, malignant diseases. However, endoscopists do not normal y perform bronchoscopic biopsy in case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bron-choscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormali-ties undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The in-clusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage (BAL) according to the images obtained from high-resolution computed tomography (HRCT). Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion (central, peripheral, or intermediate); tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen (CEA) value were col ected. The Pearson chi-square test or Fisher’s exact and McNemar tests were used in the univariate analysis. Results Among the 109 patients, the diagnosis of 37 (33.9%) patients was confirmed through bronchos-copy. Brushing and BAL had higher positive detection rates than biopsy (P = 0.004). There were no dif er-ences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value (P > 0.05 for al groups). Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscopic examination.

  6. Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

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    Miraglia, Roberto, E-mail: rmiraglia@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Vitulo, Patrizio, E-mail: pvitulo@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Maruzzelli, Luigi, E-mail: lmaruzzelli@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Burgio, Gaetano, E-mail: gburgio@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Operating Room Service, Department of Anesthesia and Intensive Care (Italy); Caruso, Settimo, E-mail: secaruso@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Bertani, Alessandro, E-mail: abertani@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Thoracic Surgery and Lung Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Callari, Adriana, E-mail: acallari@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Luca, Angelo, E-mail: aluca@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy)

    2016-03-15

    Airway stenosis is a major complication after lung transplantation that is usually managed with a combination of interventional endoscopic techniques, including endobronchial debridement, balloon dilation, and stent placement. Herein, we report a successful case of recanalization of a complete stenosis of the right middle lobe bronchus in a lung transplant patient, by using a combined percutaneous–bronchoscopic approach after the failure of endobronchial debridement.

  7. The lung volume reduction coil for the treatment of emphysema : a new therapy in development

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    Klooster, Karin; ten Hacken, Nick H. T.; Slebos, Dirk-Jan

    2014-01-01

    Lung volume reduction (LVR) coil treatment is a novel therapy for patients with severe emphysema. In this bilateral bronchoscopic treatment, approximately 10 LVR coils per lobe are delivered under fluoroscopic guidance in two sequential procedures. The LVR coil reduces lung volume by compressing the

  8. Bronchoscopic interventions for chronic obstructive pulmonary disease

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    Mineshita, Masamichi; Slebos, Dirk-Jan

    2014-01-01

    Over the past decade, several non-surgical and minimally invasive bronchoscopic lung volume reduction (BLVR) techniques have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR can be significantly efficacious, suitable for a broad cohort of patients, and

  9. Automated segmentation of lung airway wall area measurements from bronchoscopic optical coherence tomography imaging

    Science.gov (United States)

    Heydarian, Mohammadreza; Choy, Stephen; Wheatley, Andrew; McCormack, David; Coxson, Harvey O.; Lam, Stephen; Parraga, Grace

    2011-03-01

    Chronic Obstructive Pulmonary Disease (COPD) affects almost 600 million people and is currently the fourth leading cause of death worldwide. COPD is an umbrella term for respiratory symptoms that accompany destruction of the lung parenchyma and/or remodeling of the airway wall, the sum of which result in decreased expiratory flow, dyspnea and gas trapping. Currently, x-ray computed tomography (CT) is the main clinical method used for COPD imaging, providing excellent spatial resolution for quantitative tissue measurements although dose limitations and the fundamental spatial resolution of CT limit the measurement of airway dimensions beyond the 5th generation. To address this limitation, we are piloting the use of bronchoscopic Optical Coherence Tomography (OCT), by exploiting its superior spatial resolution of 5-15 micrometers for in vivo airway imaging. Currently, only manual segmentation of OCT airway lumen and wall have been reported but manual methods are time consuming and prone to observer variability. To expand the utility of bronchoscopic OCT, automatic and robust measurement methods are required. Therefore, our objective was to develop a fully automated method for segmenting OCT airway wall dimensions and here we explore several different methods of image-regeneration, voxel clustering and post-processing. Our resultant automated method used K-means or Fuzzy c-means to cluster pixel intensity and then a series of algorithms (i.e. cluster selection, artifact removal, de-noising) was applied to process the clustering results and segment airway wall dimensions. This approach provides a way to automatically and rapidly segment and reproducibly measure airway lumen and wall area.

  10. Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation)

    Science.gov (United States)

    Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.

    2016-03-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a 3 year survival rate of 50%. Diagnostic certainty of IPF is essential to determine the most effective therapy for patients, but often requires surgery to resect lung tissue and look for microscopic honeycombing not seen on chest computed tomography (CT). Unfortunately, surgical lung resection has high risks of associated morbidity and mortality in this patient population. We aim to determine whether bronchoscopic optical coherence tomography (OCT) can serve as a novel, low-risk paradigm for in vivo IPF diagnosis without surgery or tissue removal. OCT provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We have designed bronchoscopic OCT catheters to effectively and safely access the peripheral lung, and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We utilized these OCT catheters to perform bronchoscopic imaging in lung tissue from patients with pulmonary fibrosis to determine if bronchoscopic OCT could successfully visualize features of IPF through the peripheral airways. OCT was able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (fibrosis, and spatial disease heterogeneity. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.

  11. 纤维支气管镜肺减容术治疗绵羊肺气肿模型的实验研究%Treatment of pulmonary emphysema sheep model through bronchoscopic lung volume reduction:an experimental study

    Institute of Scientific and Technical Information of China (English)

    冯志军; 路武杰; 滕伟; 郭俊华; 黄志昂; 王红燕; 靳建军; 王静

    2014-01-01

    目的:探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法:将16只6月龄雌性绵羊随机分为A、B2组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,2组均给予内科治疗.分别测2组绵羊术前和术后24 h、4、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV10),且进行比较,A组定期行胸部CT检查,2组动物治疗8周均予以处死,行病理学检查.结果:①成功复制绵羊肺气肿动物模型16只,A组术中、术后无并发症出现;②A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;③2组不同时间点FEV10水平差异有统计学意义(F时间=1 352.409,P=0.000),2种治疗手段效果差异有统计学意义(F组间=5 004.278,P=0.000),治疗手段和时间之间有交互作用(F交互=1 325.058,P=0.000);④病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论:该技术治疗绵羊肺气肿模型具有有效性及优越性.

  12. Lung volume reduction coil treatment for patients with severe emphysema : a European multicentre trial

    NARCIS (Netherlands)

    Deslee, Gaetan; Klooster, Karin; Hetzel, Martin; Stanzel, Franz; Kessler, Romain; Marquette, Charles-Hugo; Witt, Christian; Blaas, Stefan; Gesierich, Wolfgang; Herth, Felix J. F.; Hetzel, Juergen; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial

  13. Diagnostic concordance of histologic lung cancer type between bronchial biopsy and cytology specimens taken during the same bronchoscopic procedure.

    Science.gov (United States)

    Sackett, Melanie K; Salomão, Diva R; Donovan, Janis L; Yi, Eunhee S; Aubry, Marie Christine

    2010-10-01

    The diagnosis of lung cancer is often confirmed by cytology and biopsy specimens obtained during a bronchoscopic procedure. At our institution, these specimens are read by different pathologists, and the rate of concordance was not known. To evaluate the concordance rate in the diagnosis of lung cancer types between cytology and biopsy specimens and to correlate discordance with patient outcome. Specimens obtained during the same procedure, between January 1, 2000, and December 31, 2005, were identified. Cases with cytology and biopsy specimens positive for cancer were evaluated for concordance of histologic type, small cell versus non–small cell lung carcinoma. Cases with different types were considered discordant, and slides were reviewed. Of 231 cases, 225 (97.4%) had concordant diagnoses. Discordance was the result of misinterpretation of undifferentiated carcinoma, overinterpretation of squamous dysplasia, interpretation of suboptimal specimens with necrosis and crush artifact, and sampling error. Even though the cytology and biopsy specimens were reviewed by different pathologists, the concordance rate for histologic type at our institution was high, emphasizing that this is a safe practice. The few discordant cases did not affect the patient's outcome.

  14. Low cost biological lung volume reduction therapy for advanced emphysema

    Directory of Open Access Journals (Sweden)

    Bakeer M

    2016-08-01

    Full Text Available Mostafa Bakeer,1 Taha Taha Abdelgawad,1 Raed El-Metwaly,1 Ahmed El-Morsi,1 Mohammad Khairy El-Badrawy,1 Solafa El-Sharawy2 1Chest Medicine Department, 2Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Bronchoscopic lung volume reduction (BLVR, using biological agents, is one of the new alternatives to lung volume reduction surgery.Objectives: To evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue.Methods: Enrolled patients were divided into two groups: group A (seven patients in which autologous blood was used and group B (eight patients in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications.Results: In group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted (P-value: <0.001 and 0.038, respectively. In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted (P-value: 0.005 and 0.004, respectively. All patients tolerated the procedure with no mortality.Conclusion: BLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness. Keywords: BLVR, bronchoscopy, COPD, interventional pulmonology

  15. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    2013-06-01

    Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  16. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Zhang Yu; Yu Like; Xie Haiyan; Hu Weihua; Hao Keke; Xia Ning

    2013-01-01

    Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods:The clinical features of2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results:The ratio of male/female was 4.8:1 and the peak onset age was 60~69 years old. The major pathological type was squamous cell carcinoma (44.5%), then adenocarcinoma (25.9%) and small cell lung cancer (18.3%). The incidence of squamous cell carcinoma was the highest in males (50.6%), while that of adenocarcinoma in females (56.2%). The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can signiifcantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  17. Novel bronchoscopic strategies for the diagnosis of peripheral lung lesions: present techniques and future directions.

    Science.gov (United States)

    Gilbert, Christopher; Akulian, Jason; Ortiz, Ricardo; Lee, Hans; Yarmus, Lonny

    2014-07-01

    The diagnosis of the peripheral lung lesion has been a long-standing clinical challenge--balancing accuracy with patient safety. With recent data revealing mortality benefits with lung cancer screening via low-dose computed tomography, now more than ever, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary nodule. In this review, we present available technologies to aid clinicians in attempts at minimally invasive techniques and the data supporting their use. In addition, we review novel tools under investigation that may further increase yield and provide additional benefit in obtaining an early diagnosis of lung cancer.

  18. Bronchoscopic lung volumen reduction is a treatment offered to patients with severe heterogenous emphysema

    DEFF Research Database (Denmark)

    Bendstrup, Elisabeth; Hilberg, Ole

    2014-01-01

    interstitial pneumonia on high resolution computed tomography or specific combinations of radiological and histopathological patterns. All patients should be evaluated for lung transplantation, and treatment with the anti-fibrotic drug pirfenidone is recommended for patients with a forced vital capacity > 50...

  19. Lung volume reduction for severe emphysema: do we need a scalpel or a scope?

    Directory of Open Access Journals (Sweden)

    D. Van Raemdonck

    2010-09-01

    Full Text Available Resectional lung volume reduction has proven to be superior to medical treatment in reducing dyspnoea and in increasing lung function, survival and quality of life in a very well selected, low risk group of hyperinflated patients with heterogeneous emphysema predominantly in the upper lobe. Nevertheless, this intervention is hampered by an important pulmonary (30% and cardiovascular (20% morbidity, mainly as a result of prolonged (>7 days air leak, and a 5% risk of death as a result of the surgical intervention. Results from ongoing randomised trials are awaited in order to determine whether less invasive, non-resectional lung volume treatment of emphysema via the bronchoscope using endobronchial valves, airway bypass stents or biological adhesives/heated water vapour will yield similar improvement with less morbidity and reduced mortality, compared with surgical resection. Furthermore, it is hoped that endoscopic lung volume reduction techniques may help patients with homogeneous emphysema currently excluded by most teams for the resectional procedure.

  20. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation

    Science.gov (United States)

    Amin, Nayana; Tarwade, Pritee; Shetmahajan, Madhavi; Pramesh, C. S.; Jiwnani, Sabita; Mahajan, Abhishek; Purandare, Nilendu

    2016-01-01

    Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12-month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB. PMID:27052065

  1. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one - lung ventilation

    Directory of Open Access Journals (Sweden)

    Nayana Amin

    2016-01-01

    Full Text Available Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT and bronchial blockers (BBs with the pediatric fiberoptic bronchoscope (FOB is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years undergoing thoracic surgery over a 12-month period. In the study group (n = 38, measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46, DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients, preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44 to 50% (18/36 (P = 0.04. Our incidence of failed device placement at initial insertion was 4.7% (4/84. Incidence of malposition was 10% (8/80 with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36 versus 65.9% (29/44. Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.

  2. Technology update: bronchoscopic thermal vapor ablation for managing severe emphysema

    Directory of Open Access Journals (Sweden)

    Gompelmann D

    2014-09-01

    Full Text Available Daniela Gompelmann,1,2 Ralf Eberhardt,1,2 Felix JF Herth1,21Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, 2German Center for Lung Research, Heidelberg, GermanyAbstract: Bronchoscopic thermal vapor ablation (BTVA is an endoscopic lung volume reduction therapy that presents an effective treatment approach in patients with severe upper lobe-predominant emphysema. By instillation of heated water vapor, an inflammatory reaction is induced, leading to fibrosis and scarring of the lung parenchyma, resulting in lobar volume reduction. Clinical single-arm trials demonstrated great outcomes, with significant improvement of lung function, exercise capacity, and quality of life. As the BTVA-induced local inflammatory response that seems to be essential for the desired lobar volume reduction can be associated with transient clinical worsening, strict monitoring of the patients is required. In future, the balance between efficacy and safety will constitute a major challenge. This review summarizes the BTVA procedure, the mechanism of action, and the results of the clinical trials, including the efficacy and safety data.Keywords: emphysema, bronchoscopy, bronchoscopic thermal vapor ablation

  3. 经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性%The effectiveness and superiority of establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

    Institute of Scientific and Technical Information of China (English)

    冯志军; 路武杰; 郭俊华; 黄志昂; 王红燕; 靳建军; 王静

    2013-01-01

    目的 探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法 将16只6月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,同时给予内科治疗,B组仅给予内科治疗.分别测两组绵羊术前和术后24h、4周、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV1.0),且进行比较;A组定期行胸部CT检查,治疗8周处死动物,行病理学检查.结果 成功复制绵羊肺气肿动物模型16只,A组术前、术中、术后无明显异常;A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;两组不同时间点FEV1.0水平差异有统计学意义(F时间=1352.409,P<0.001),两种治疗手段效果差异有统计学意义(F组间=5004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1325.058,P<0.001);病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论 该技术治疗绵羊肺气肿模型具有有效性及优越性.

  4. Descriptive data on cancerous lung lesions detected by auto-fluorescence bronchoscope: A five-year study

    Directory of Open Access Journals (Sweden)

    Asmitananda Thakur

    2012-01-01

    Full Text Available Background: Auto-fluorescence bronchoscopy (AFB has been used for the identification and localization of intra-epithelial pre-neoplastic and neoplastic lesions within the bronchus. Objectives: To determine the applicability of AFB for the detection and localization of precancerous and cancerous lesions, in addition to analyzing the morphologic presentation, their association to histological type and the variation between genders. Methods: A five-year study involving 4983 patients, who underwent routine bronchoscopy [B] examination in a local tertiary teaching hospital, was done. The B examination was performed under intratracheal lidocaine, and samples were obtained using suitable approach. One thousand four hundred and eighty-five pathologically confirmed lung cancer patients were included in the study. The following parameters were studied: Morphological presentation, biopsy sites, histology. Differences between the groups were analyzed using Chi square test. Result: One thousand four hundred and eighty-five patients who had hyperplasia or neoplastic lesions were further confirmed as lung cancer pathologically. Lung cancer was more commonly found in the right lung (51.58% vs. 42.82%. The lesion occurred more frequently in the upper lobe than the lower lobe (44.17% vs. 22.42%. Male patients with squamous cell carcinoma showed upper lobe involvement more commonly, while the left main bronchus was more commonly involved in female patients. Adenocarcinoma mostly involved lesion of the upper lobe. Squamous cell carcinoma and small cell carcinoma were the major proliferative types (80.15% and 76.16% respectively. Conclusion: AFB is efficient in the detection of pre-invasive and invasive lung lesions. The morphological presentation is associated to the histological type. There is variation in the presentation and histology of cancerous lung lesions between genders.

  5. [The importance of bronchoscopic anatomy for anesthesiologists].

    Science.gov (United States)

    Hoşten, Tülay; Topçu, Salih

    2011-01-01

    One-lung ventilation (OLV) is a sine qua non of thoracic surgery and requires knowledge and talent. Close familiarity with equipments used for OLV as well as bronchoscopy and respiratory tract anatomy is important for successful OLV. We aim to outline the bronchoscopic anatomy of the tracheobronchial tree and OLV equipment for anesthetists and thoracic surgeons in this review. The recorded preoperative and intraoperative bronchoscopic applications of the patients hospitalized in our Thoracic Surgery clinic for diagnosis and treatment have been evaluated from an anesthetist's perspective. Anatomic landmarks were identified in the bronchoscopic evaluation. Optimal and misplacement images of double-lumen tubes (DLT) and bronchial blockers (BB) used for OLV in our clinic were obtained via fiber optic bronchoscopy. While left lung isolation can be made more safely due to the anatomy of the left main bronchus, placement of both DLTs and BBs to the right main bronchus requires greater care. Success in OLV procedures would increase with anesthetists being well informed about the fiber optic bronchoscopic anatomy of the tracheobronchial tree and in close cooperation with the surgical team.

  6. Treatment of isolated mediastinal and hilar recurrence of lung cancer with bronchoscopic endobronchial ultrasound guided intratumoral injection of chemotherapy with cisplatin.

    Science.gov (United States)

    Mehta, Hiren J; Begnaud, Abbie; Penley, Andrea M; Wynne, John; Malhotra, Paras; Fernandez-Bussy, Sebastian; Cope, Jessica M; Shuster, Jonathan J; Jantz, Michael A

    2015-12-01

    A common pattern of recurrence in lung cancer after receiving full dose external beam radiation therapy (EBRT) to targeted sites is isolated mediastinal and hilar recurrence (IMHR). Treatment options for these patients are limited to palliative radiation, chemotherapy, and/or best supportive care. We describe our experience with treating IMHR with bronchoscopic endobronchial ultrasound (EBUS) guided intratumoral injection of cisplatin (ITC). Patients treated between Jan 2009-September 2014 with ITC for IMHR were included. Patient demographics, tumor histology, size, concurrent therapy, location, number of sites treated, treatment sessions, and encounters were abstracted. Responses were analyzed on follow-up scans 8-12 weeks after the last treatment session using RECIST 1.1 criteria. Locoregional recurrence, progression-free survival (PFS), and overall survival were measured. 50 sites were treated in 36 patients (19 males, 17 females) with mean age 61.9±8.5 years. Eight sites treated on subsequent encounters were excluded and one patient had an unevaluable response, leaving 35 patients and 41 sites for final analysis. 24/35 (69%) had complete or partial response (responders), whereas 11/35 (31%) had stable or progressive disease (non-responders). There were no significant differences in response based on histology, size, and concurrent therapy. Median survival for the group was 8 months (95% CI of 6-11 mo). Responders had significantly higher survival and PFS than non-responders. Two patients treated with concurrent EBRT, developed broncho-mediastinal fistula. EBUS guided intratumoral cisplatin for IMHR appears to be safe and effective, and may represent a new treatment paradigm for this patient population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Carcinoid tumours of the lung and the ‘PEPPS’ approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery

    Science.gov (United States)

    Neuberger, Michael; Hapfelmeier, Alexander; Schmidt, Michael; Gesierich, Wolfgang; Reichenberger, Frank; Morresi-Hauf, Alicia; Hatz, Rudolf A; Lindner, Michael

    2015-01-01

    Background Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking. Methods In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival. Results 132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups. Conclusions After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates. PMID:26203359

  8. Bronchoscopic management of malignant airway obstruction.

    Science.gov (United States)

    Mitchell, Patrick D; Kennedy, Marcus P

    2014-05-01

    Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.

  9. 支气管镜下常用检查方式在肺癌诊断中的意义%The Clinical Significance of Different Sampling under Bronchoscope for Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    刘倩

    2016-01-01

    Objective To investigate the clinical significance of electronic bronchoscope in the diagnosis of lung cancer. Methods Group selection a retrospective analysis Wannan Medical College Hospital August 2011 to August 2012,289 cas-es of lung cancer. The diagnostic positive rate was compared among forceps biopsy, brush biopsy and postoperative sputum cytology. Results The pathological types included squamous cell carcinoma (51.6%),adenocarcinoma (28.7%),and small cell lung cancer(13.8%).The positive rate of forceps biopsy, brush biopsy and postoperative sputum cytology was 84.0%, 26.0%and 7.0%,respectively.The combined bronchoscopic biopsy were higher than forceps biopsy (P>0.05). Conclusion Forceps biopsy was an important way of examinations. The combined bronchoscopic biopsy can increase the detectable rate of lung cancer.%目的:探讨电子支气管镜在肺癌诊断中的临床意义。方法整群选取并回顾性分析皖南医学院附属医院2011年8月―2012年8月确诊肺癌的289例患者临床资料,比较支气管镜下使用不同检查方法诊断肺癌的阳性率。结果该组最常见的为鳞癌,其次为腺癌和小细胞癌。200例联合检查患者钳检阳性率为84.0%,刷检阳性率为26.0%,支气管镜术后痰检阳性率7.0%。钳检、刷检和术后痰检3种联合检查阳性率稍高于单纯钳检,但差异无统计学意义。结论钳检为重要的取材方式,联合检查有助于肺癌的诊断。

  10. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT: a non-surgical method of lung volume reduction

    Directory of Open Access Journals (Sweden)

    Noppen Marc

    2007-07-01

    Full Text Available Abstract Background Lung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently, less invasive bronchoscopic approaches have been designed to utilize these principles while avoiding the associated perioperative risks. The Endobronchial Valve for Emphysema PalliatioN Trial (VENT posits that occlusion of a single pulmonary lobe through bronchoscopically placed Zephyr® endobronchial valves will effect significant improvements in lung function and exercise tolerance with an acceptable risk profile in advanced emphysema. Methods The trial design posted on Clinical trials.gov, on August 10, 2005 proposed an enrollment of 270 subjects. Inclusion criteria included: diagnosis of emphysema with forced expiratory volume in one second (FEV1 100%; residual volume > 150% predicted, and heterogeneous emphysema defined using a quantitative chest computed tomography algorithm. Following standardized pulmonary rehabilitation, patients were randomized 2:1 to receive unilateral lobar placement of endobronchial valves plus optimal medical management or optimal medical management alone. The co-primary endpoint was the mean percent change in FEV1 and six minute walk distance at 180 days. Secondary end-points included mean percent change in St. George's Respiratory Questionnaire score and the mean absolute changes in the maximal work load measured by cycle ergometry, dyspnea (mMRC score, and total oxygen use per day. Per patient response rates in clinically significant improvement/maintenance of FEV1 and six minute walk distance and technical success rates of valve placement were recorded. Apriori response predictors based on quantitative CT and lung physiology were defined. Conclusion If endobronchial valves improve FEV1 and health status with an acceptable safety profile in advanced emphysema, they would offer a novel intervention for this progressive and

  11. Can Bronchoscopic Airway Anatomy Be an Indicator of Autism?

    Science.gov (United States)

    Stewart, Barbara A.; Klar, Amar J. S.

    2013-01-01

    Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated "doublets") in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited…

  12. 重度肺气肿的内镜下肺减容治疗技术%Application of endoscopic lung volume reduction technique in severe emphysema

    Institute of Scientific and Technical Information of China (English)

    迟晶; 郭述良; 贾晋伟; 李一诗

    2013-01-01

    慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)在世界范围的发病率和死亡率占主要因素.COPD发展至重度肺气肿阶段时严重影响患者生活质量.内镜肺减容术(endoscopic lung volume reduction,ELVR)是通过支气管镜技术使过度充气的肺叶产生不张,疗效较传统的内科治疗更为确切,与外科肺减容术相比,ELVR以其微创,操作相对简单,并发症和死亡率降低等优点,引起了世界医学界的广泛研究.目前国内外研究较多的内镜下肺减容技术主要包括支气管内单向活瓣技术(one-way endobronchial valves,EBV)、气道旁路支架(airway bypass stents,ABS)、聚合物肺减容术(polymeric lung volume reduction,PLVR)、经支气管镜热蒸汽消融术(bronchoscopic thermal vapor ablation,BTVA)和肺减容弹簧圈(lung volume reduction coil,LVRC)等5种.本文将就上述内镜肺减容技术作一综述.%Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide.Once the disease develops into severe emphysema,it seriously affects the patients' life quality.Endoscopic lung volume reduction(ELVR) with bronchoscopic techniques to bring about atelectasis of the hyperinflated lobe has been developed and studied widely over the past decade,because it has a better clinical effect than the traditional medicine treatment.The techniques have the advantages of minimally invasive and simple with less complications and lower mortality compared to the open surgical approach.Nowadays the most commonly used ELVR techniques include one-way endobronchial valves (EBV),airway bypass stents (ABS),polymeric lung volume reduction (PLVR),bronchoscopic thermal vapor ablation (BTVA) and lung volume reduction coil (LVRC).In this paper the ELVR techniques are reviewed.

  13. Evaluation of the jet injector in paediatric fibreoptic bronchoscopes.

    Science.gov (United States)

    Sloan, I A; McLeod, M E

    1985-01-01

    The use of the Sanders venturi system during bronchoscopy in adults has been studied extensively. Its use in paediatric bronchoscopy has been limited because small changes in the characteristics of the system may produce large changes in the patient. With jet ventilation, peak inflation pressures and flow rates are influenced by the driving pressure, diameter and shape of the bronchoscope, the diameter of the injector and its length and angle from the axial line of the bronchoscope. Storz 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were evaluated in a test lung with an injector of 1.5 mm internal diameter fixed in the side-arm at 20 degrees to the axial line. Pilling 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were also examined using the standard injector with a 0.89 mm orifice in the axial line. The Storz bronchoscopes produced consistently higher peak inflation pressures and flow rates at all driving pressures in spite of the relatively large angle of the injector from the axial line. Caution is advised in the use of the Storz injector system as excessively high inflation pressures may be reached.

  14. Update on Nonsurgical Lung Volume Reduction Procedures

    Directory of Open Access Journals (Sweden)

    J. Alberto Neder

    2016-01-01

    Full Text Available There has been a surge of interest in endoscopic lung volume reduction (ELVR strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR, bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC 225% predicted and thoracic hyperinflation (TLC > 150% predicted have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order are the next logical alternatives.

  15. Lung Volume Measured during Sequential Swallowing in Healthy Young Adults

    Science.gov (United States)

    Hegland, Karen Wheeler; Huber, Jessica E.; Pitts, Teresa; Davenport, Paul W.; Sapienza, Christine M.

    2011-01-01

    Purpose: Outcomes from studying the coordinative relationship between respiratory and swallow subsystems are inconsistent for sequential swallows, and the lung volume at the initiation of sequential swallowing remains undefined. The first goal of this study was to quantify the lung volume at initiation of sequential swallowing ingestion cycles and…

  16. October 2015 Phoenix pulmonary journal club: lung volume reduction

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. The October 2015 pulmonary journal club focused on the review of older studies evaluating lung volume reduction surgery and how this has transitioned toward the development of non-surgical modes of lung volume reduction. The physiology behind dyspnea in chronic obstructive pulmonary disease (COPD is a complex process. One of the proposed mechanisms has been hyperinflation associated with air trapping. In the mid 1990s studies by Cooper and Peterson (1 offered a promising approach in which lung volume reduction (LVR could improve ventilatory mechanics and improve dyspnea. As the procedure gained more popularity, additional larger scale trials were performed to support its validity. We reviewed 2 studies looking at lung volume reduction. The first was "The Effect of Lung Volume Reduction Surgery In Patients With Severe Emphysema” (2 . This was a smaller, randomized controlled trial (RCT that looked at 2 groups of 24 patients. Once group received LVR while the ...

  17. MR assessment of fetal lung development using lung volumes and signal intensities

    Energy Technology Data Exchange (ETDEWEB)

    Keller, Thomas M.; Michel, Sven C.A.; Marincek, Borut [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich (Switzerland); Rake, Annett; Wisser, Josef [Department of Obstetrics, University Hospital Zurich, Raemistrasse 100, 8091, Zurich (Switzerland); Seifert, Burkhardt [Department of Biostatistics, University of Zurich, Sumatrastrasse 30, 8006, Zurich (Switzerland); Kubik-Huch, Rahel A. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich (Switzerland); Institute of Radiology, Kantonsspital Baden, 5404, Baden (Switzerland)

    2004-06-01

    The purpose of this study was to evaluate the monitoring and diagnostic potential of MRI in fetal lung development and disease using lung volume and signal intensity changes through gestation. Thirty-five healthy fetuses (22-42 weeks) were examined on a 1.5- T MR system using sagittal T2w single-shot fast spin-echo imaging (TR indefinite, TE 90 ms, slice thickness/gap 3-5/0 mm, FOV 26-40 cm, NEX 0.5). Fetal body and lung were segmented manually and volumes calculated. Signal intensities (SI) of fetal lung and three reference values were measured on the section best displaying the lung. Regions of interests were defined by including the maximal organ area possible. The following SI ratios were generated: lung/liver, lung/amniotic fluid, lung/muscle, liver/fluid and liver/muscle. Volumes and ratios were correlated with gestational age. Data from seven fetuses with pulmonary pathology were compared with these normative values. Absolute lung volume varied from 12.3 to 143.5 cm{sup 3} in correlation with gestational age (P<0.001); lung volume relative to total body volume ranged from 1.6 to 5.0%, decreasing with gestational age (P=0.001). (orig.)

  18. VARIATION OF LUNG DEPOSITION OF MICRON SIZE PARTICLES WITH LUNG VOLUME AND BREATHING PATTERN

    Science.gov (United States)

    Lung volume and breathing pattern are the source of inter-and intra-subject variability of lung deposition of inhaled particles. Controlling these factors may help optimize delivery of aerosol medicine to the target site within the lung. In the present study we measured total lu...

  19. Impact of endoscopic lung volume reduction on right ventricular myocardial function.

    Directory of Open Access Journals (Sweden)

    Carmen Pizarro

    Full Text Available Endoscopic lung volume reduction (ELVR provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis.We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc., comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval.Patients were predominantly of late middle-age (65.8 ± 8.7 yrs, male (62.5% and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively. After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96 ± 7.02% vs. -13.35 ± 11.48%, p = 0.04, whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p = 0.03. However, clinical non-responders did not exhibit any RtV functional improvement.ELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.

  20. Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer.

    Science.gov (United States)

    Sanz-Santos, José; Serra, Pere; Andreo, Felipe; Torky, Mohamed; Centeno, Carmen; Morán, Teresa; Carcereny, Enric; Fernández, Esther; García-Reina, Samuel; Ruiz-Manzano, Juan

    2017-02-28

    The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

  1. Radiation dose-volume effects in the lung

    DEFF Research Database (Denmark)

    Marks, Lawrence B; Bentzen, Soren M; Deasy, Joseph O;

    2010-01-01

    The three-dimensional dose, volume, and outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold "tolerance dose-volume" levels. There are strong volume and fractionation effects....

  2. Effect of increases in lung volume on clearance of aerosolized solute from human lungs

    Energy Technology Data Exchange (ETDEWEB)

    Marks, J.D.; Luce, J.M.; Lazar, N.M.; Wu, J.N.; Lipavsky, A.; Murray, J.F.

    1985-10-01

    To study the effect of increases in lung volume on solute uptake, we measured clearance of /sup 99m/Tc-diethylenetriaminepentaacetic acid (Tc-DTPA) at different lung volumes in 19 healthy humans. Seven subjects inhaled aerosols (1 micron activity median aerodynamic diam) at ambient pressure; clearance and functional residual capacity (FRC) were measured at ambient pressure (control) and at increased lung volume produced by positive pressure (12 cmH2O continuous positive airway pressure (CPAP)) or negative pressure (voluntary breathing). Six different subjects inhaled aerosol at ambient pressure; clearance and FRC were measured at ambient pressure and CPAP of 6, 12, and 18 cmH2O pressure. Six additional subjects inhaled aerosol at ambient pressure or at CPAP of 12 cmH2O; clearance and FRC were determined at CPAP of 12 cmH2O. According to the results, Tc-DTPA clearance from human lungs is accelerated exponentially by increases in lung volume, this effect occurs whether lung volume is increased by positive or negative pressure breathing, and the effect is the same whether lung volume is increased during or after aerosol administration. The effect of lung volume must be recognized when interpreting the results of this method.

  3. High lung volume increases stress failure in pulmonary capillaries

    Science.gov (United States)

    Fu, Z.; Costello, M. L.; Tsukimoto, K.; Prediletto, R.; Elliott, A. R.; Mathieu-Costello, O.; West, J. B.

    1992-01-01

    We previously showed that when pulmonary capillaries in anesthetized rabbits are exposed to a transmural pressure (Ptm) of approximately 40 mmHg, stress failure of the walls occurs with disruption of the capillary endothelium, alveolar epithelium, or sometimes all layers. The present study was designed to test whether stress failure occurred more frequently at high than at low lung volumes for the same Ptm. Lungs of anesthetized rabbits were inflated to a transpulmonary pressure of 20 cmH2O, perfused with autologous blood at 32.5 or 2.5 cmH2O Ptm, and fixed by intravascular perfusion. Samples were examined by both transmission and scanning electron microscopy. The results were compared with those of a previous study in which the lung was inflated to a transpulmonary pressure of 5 cmH2O. There was a large increase in the frequency of stress failure of the capillary walls at the higher lung volume. For example, at 32.5 cmH2O Ptm, the number of endothelial breaks per millimeter cell lining was 7.1 +/- 2.2 at the high lung volume compared with 0.7 +/- 0.4 at the low lung volume. The corresponding values for epithelium were 8.5 +/- 1.6 and 0.9 +/- 0.6. Both differences were significant (P less than 0.05). At 52.5 cmH2O Ptm, the results for endothelium were 20.7 +/- 7.6 (high volume) and 7.1 +/- 2.1 (low volume), and the corresponding results for epithelium were 32.8 +/- 11.9 and 11.4 +/- 3.7. At 32.5 cmH2O Ptm, the thickness of the blood-gas barrier was greater at the higher lung volume, consistent with the development of more interstitial edema. Ballooning of the epithelium caused by accumulation of edema fluid between the epithelial cell and its basement membrane was seen at 32.5 and 52.5 cmH2O Ptm. At high lung volume, the breaks tended to be narrower and fewer were oriented perpendicular to the axis of the pulmonary capillaries than at low lung volumes. Transmission and scanning electron microscopy measurements agreed well. Our findings provide a physiological

  4. ALK protein expression and gene fusion in bronchoscopic specimens of lung adenocarcinoma%检测肺腺癌活检标本间变性淋巴瘤激酶蛋白表达和基因融合

    Institute of Scientific and Technical Information of China (English)

    梁小龙; 王孟昭; 张静; 罗玉凤; 张淑英; 武莎斐; 刘媛媛; 曾瑄

    2014-01-01

    Objective To explore ALK protein expression and gene fusion in formalin-fixed and paraffin-embedded (FFPE) specimens obtained from lung cancer by bronchoscopy,and to investigate the relationship between ALK status and clinicopathological characteristics of the patients.Methods Seventyfour FFPE samples obtained from lung adenocarcinoma by bronchoscopy were tested for ALK protein expression and gene fusion respectively by immunohistochemistry (IHC) using Ventana D5F3 antibody and fluorescence in situ hybridization (FISH) using ALK break apart probe.Results sixty-five of the 74 samples were successfully tested by FISH (87.8%,65/74).There were 5 FISH-positive cases (7.7%,5/65),all with advanced stage carcinoma.Among these five FISH-positive cases,3 were IHC-positive (4.1%,3/74) and 2 IHC-negative cases.All the other 69 samples were IHC-negative,including nine FISH-uninformative samples (7 samples were less than 50 tumor cells and 2 samples with weak FISH signal).Both ALK IHC and FISH results were not correlated with age,sex,history of smoking,histological classification,differentiation and lymph node metastasis.Conclusions Bronchoscopic specimens of lung cancer can be used to detect ALK expression and gene fusion.Inmunohistochemistry in combination with FISH test may be more favorable for ALK test.%目的 探讨采用肺腺癌支气管镜活检标本检测间变性淋巴瘤激酶(ALK)蛋白表达和基因融合的可行性,及其与临床病理特征的关系.方法 74例福尔马林固定石蜡包埋的肺腺癌支气管镜活检标本,采用Bench Mark全自动免疫组化染色机和D5F3抗体试剂盒,以免疫组化法检测ALK蛋白的表达,采用Abbott ALK分离探针,以荧光原位杂交(FISH)法检测ALK基因融合.结果 74例标本中,65例成功地进行了FISH检测,成功检测率为87.8% (65/74);FISH阳性5例,阳性率为7.7%(5/65),均为中晚期低分化腺癌;其中免疫组化阳性3例,阳性率为4.1% (3/74);另2

  5. 支气管镜肺减容现状和展望%Current status and prospects of lung volume reduction surgery

    Institute of Scientific and Technical Information of China (English)

    孙沁莹; 林冰

    2013-01-01

    The application of lung volume reduction surgery (LVRS) in clinical practice is limited by high postoperative morbidity and stringent selection criteria. Bronchoscopic lung-volume reduction has recently been explored as safer alternatives to LVRS for treating advanced emphysema. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive and subjective benefit in dyspnoea scores,6MWT distance (6MWD) ,quality of life (SCRQ) are more frequent findings than improvements on spirometry or exercise tolerance. Safety data are more promising with rare procedure-related mortality, short hospital length of stay and few complications such as COPD exacerbation, peumonia, pneumo-thorax. The field of bronrhoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials build on earlier feasibility data to clarify the true efficacy of such techniques.%外科肺减容手术治疗重度肺气肿术后病死率较高,适应证少,不适宜临床推广.支气管镜肺减容术通过支气管镜下的技术操作,简便、安全,有望替代外科肺减容术治疗重度肺气肿.目前研究比较有效的方法有支气管腔内单向阀、生物胶、蒸汽消融和肺减容线圈.支气管镜肺减容术治疗重度肺气肿,可以明显改善气促指数、6 min步行距离及生活质量(SGRQ)评分等主观指标,但对于评价该项技术有效性的客观指标如肺功能指标及运动耐力仅有部分改善.采用该项技术安全性好,住院时间短,极少出现危及生命的严重并发症,可能出现的并发症包括慢性阻塞性肺疾病急性加重、肺炎和气胸.下一步需开展前瞻性的随机对照研究,证实支气管镜肺减容术的确切疗效.

  6. Horse-shoe lung-rediscovered via volume rendered images

    Directory of Open Access Journals (Sweden)

    Alpa Bharati

    2013-01-01

    Full Text Available Horseshoe lung, usually associated with pulmonary venolobar syndrome, is a rare congenital anomaly involving the fusion of the postero-basal segments of the right and left lungs across the midline. The fused segment or the isthmus lies posterior to the pericardium and anterior to the aorta.The associated pulmonary venolobar syndrome involves anomalous systemic arterial supply and anomlaous systemic venous drainage of the right lung. With the advent of MDCT imaging, we can diagnose this rare condition as well all its associated anomalies non-invasively. Volume-rendered techniques greatly simplify the complex anatomy and provide easy understanding of the same.

  7. [INFLUENCE OF LIPOSUCTION OF LARGE VOLUME ON SYSTEMIC AND LUNG CIRCULATION, OXIGENATED LUNG FUNCTION].

    Science.gov (United States)

    Nikolaeva, I P; Kapranova, A S; Popova, V B; Lodyagin, A N; Frolova, T A

    2015-01-01

    The authors measured the changes of hemodynamics in 72 patients. It was also estimated a blood oxygenation and volume of liquid sectors of the organism in different degree of obesity before and after liposuction of the large volume. It was shown, that this operation facilitated to an improvement of respiratory lung function due to changes of pulmonary circulation.

  8. 气管镜诊断气管-支气管肺低度恶性肌上皮瘤2例并文献复习%Analysis of myoepithelioma in lung diagnosed by bronchoscope:two cases report and re-view of literature

    Institute of Scientific and Technical Information of China (English)

    张晓玲; 邢荣格

    2014-01-01

    Objective:To investigate the diagnosis and treatment of myoePithelial tumour of the tracheal,bron-chus,lung by bronchoscoPe. Methods:Two cases of myoePithelial tumours and rePorted in literature of domestic and overseas were retrosPective reviewed. Results:The common clinical manifestation are cough,shortness of breath and hemoPtysis. Conclusion:MyoePithelial tumour of the tracheal,bronchus,lung is a rare tumor in the lung. Because the materials from bronchoscoPe is little,the diagnosis need careful observation of the sPecimen and immnunohistochemis-try result.%目的:探讨气管镜诊断气管-支气管肺肌上皮瘤的要点及肌上皮瘤的治疗方案。方法:回顾性分析本院2例及国内外报道的气管-支气管肺肌上皮瘤病例资料和随访记录。结果:气管-支气管肺肌上皮瘤多表现为咳嗽、气促、咯血;确诊及治疗需依靠手术。结论:气管-支气管肺低度恶性肌上皮瘤是一种非常罕见的肿瘤,气管镜标本量少,需要仔细观察标本组织形态并结合免疫组化明确诊断。

  9. Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Binkley, Michael S. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Shrager, Joseph B. [Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Leung, Ann N. [Department of Radiology, Stanford University School of Medicine, Stanford, California (United States); Popat, Rita [Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California (United States); Trakul, Nicholas [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California (United States); Atwood, Todd F.; Chaudhuri, Aadel [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Maxim, Peter G. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Diehn, Maximilian, E-mail: Diehn@Stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California (United States); Loo, Billy W., E-mail: BWLoo@Stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States)

    2014-09-01

    Purpose: Lung volume reduction surgery (LVRS) improves dyspnea and other outcomes in selected patients with severe emphysema, but many have excessive surgical risk for LVRS. We analyzed the dose-volume relationship for lobar volume reduction after stereotactic ablative radiation therapy (SABR) of lung tumors, hypothesizing that SABR could achieve therapeutic volume reduction if applied in emphysema. Methods and Materials: We retrospectively identified patients treated from 2007 to 2011 who had SABR for 1 lung tumor, pre-SABR pulmonary function testing, and ≥6 months computed tomographic (CT) imaging follow-up. We contoured the treated lobe and untreated adjacent lobe(s) on CT before and after SABR and calculated their volume changes relative to the contoured total (bilateral) lung volume (TLV). We correlated lobar volume reduction with the volume receiving high biologically effective doses (BED, α/β = 3). Results: 27 patients met the inclusion criteria, with a median CT follow-up time of 14 months. There was no grade ≥3 toxicity. The median volume reduction of the treated lobe was 4.4% of TLV (range, −0.4%-10.8%); the median expansion of the untreated adjacent lobe was 2.6% of TLV (range, −3.9%-11.6%). The volume reduction of the treated lobe was positively correlated with the volume receiving BED ≥60 Gy (r{sup 2}=0.45, P=.0001). This persisted in subgroups determined by high versus low pre-SABR forced expiratory volume in 1 second, treated lobe CT emphysema score, number of fractions, follow-up CT time, central versus peripheral location, and upper versus lower lobe location, with no significant differences in effect size between subgroups. Volume expansion of the untreated adjacent lobe(s) was positively correlated with volume reduction of the treated lobe (r{sup 2}=0.47, P<.0001). Conclusions: We identified a dose-volume response for treated lobe volume reduction and adjacent lobe compensatory expansion after lung tumor SABR, consistent across

  10. 经电子支气管镜下冷冻联合化疗治疗晚期中央型肺癌的疗效观察%Curative Effect Observation of Electronic Bronchoscope Cryotherapy Combined with Chemotherapy in the Treatment of Advanced Stage Central Type Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    刘旭之; 宋卓; 迟岩; 赵鑫亮; 怀丽梅; 张淑丽

    2015-01-01

    目的:应用电子支气管镜下冷冻治疗联合化疗对晚期中央型肺癌的疗效分析.方法:选取24例晚期中央型肺癌为治疗组,随机设置24例晚期中央型肺癌(拒绝行电子支气管镜介入冷冻治疗)为对照组,给予标准化疗方案.治疗组采用OLYMPS BF-260电子支气管镜冷冻介入治疗联合(多西他赛+卡铂)方案全身静脉化疗.对照组采用单纯(多西他赛+卡铂)方案全身静脉化疗.结果:治疗组24例患者中,完全缓解(CR)8例,部分缓解(PR)12例,稳定(SD)2例,疾病进展(PD)2例,有效率(CR+PR)为83.3%;对照组24例患者中, CR2例,PR11例,SD7例,PD4例,有效率为54.2%.两组有效率比较差异有统计学意义(P<0.01).治疗组和对照组平均无疾病进展时间(progression-free survival PFS)分别为183 d和92 d,差异有统计学意义(P<0.05).结论:经电子支气管镜冷冻联合化疗治疗晚期中央型肺癌有较好的疗效,可提高晚期非小细胞肺癌的生存率.%Objective:To observe the treatment efficiency of the patients with advanced stage central type lung cancer by using electronic bronchoscope cryotherapy, combined with chemotherapy.Method:24 patients with advanced stage central type lung cancer were selected the treatment group, 24 patients with advanced stage central type lung cancer were randomly selected of the control group(refused to row electronic bronchoscope in cryotherapy),who were gived the standard chemotherapy regimens.The treatment group was treated with OLYMPS BF-260 electronic bronchoscopic cryotherapy and combined intravenous chemotherapy with the Docetaxel + Carboplatin, while the control group with intravenous chemotherapy with the Docetaxel + Carboplatin.Result:In the treatment group ,complete remission(CR) was 8 cases, partial remission(PR) was 12 cases, stable disease(SD) was 2 cases,progresive disease(PD) was 2 cases.In the control group ,CR was 2 cases,PR was 11 cases,SD was 8 cases,PD was 4 cases.The effective rate

  11. Endobronchial Valves for Endoscopic Lung Volume Reduction : Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction

    NARCIS (Netherlands)

    Slebos, Dirk-Jan; Herth, Felix J F; Valipour, Arschang

    2016-01-01

    Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in patie

  12. Comparison of actual tidal volume in neonatal lung model volume control ventilation using three ventilators.

    Science.gov (United States)

    Toyama, H; Endo, Y; Ejima, Y; Matsubara, M; Kurosawa, S

    2011-07-01

    In neonates, small changes in tidal volumes (V(T)) may lead to complications. Previous studies have shown a significant difference between ventilator-measured tidal volume and tidal volume delivered (actual V(T)). We evaluated the accuracy of three different ventilators to deliver small V(T) during volume-controlled ventilation. We tested Servo 300, 840 ventilator and Evita 4 Neoflow ventilators with lung models simulating normal and injured neonatal lung compliance models. Gas volume delivered from the ventilator into the test circuit (V(TV)) and actual V(T) to the test lung were measured using Ventrak respiration monitors at set V(T) (30 ml). The gas volume increase of the breathing circuit was then calculated. Tidal volumes of the SV300 and PB840 in both lung models were similar to the set V(T) and the actual tidal volumes in the injured model (20.7 ml and 19.8 ml, respectively) were significantly less than that in the normal model (27.4 ml and 23.4 ml). PB840 with circuit compliance compensation could not improve the actual V(T). V(TV) of the EV4N in the normal and the injured models (37.8 ml and 46.6 ml) were markedly increased compared with set V(T), and actual V(T) were similar to set V(T) in the normal and injured model (30.2 ml and 31.9 ml, respectively). EV4N measuring V(T) close to the lung could match actual V(T) to almost the same value as the set V(T) however the gas volume of the breathing circuit was increased. If an accurate value for the patient's actual V(T) is needed, this V(T) must be measured by a sensor located between the Y-piece and the tracheal tube.

  13. Pneumothorax as a complication of lung volume recruitment

    Directory of Open Access Journals (Sweden)

    Erik J.A. Westermann

    2013-06-01

    Full Text Available Lung volume recruitment involves deep inflation techniques to achieve maximum insufflation capacity in patients with respiratory muscle weakness, in order to increase peak cough flow, thus helping to maintain airway patency and improve ventilation. One of these techniques is air stacking, in which a manual resuscitator is used in order to inflate the lungs. Although intrathoracic pressures can rise considerably, there have been no reports of respiratory complications due to air stacking. However, reaching maximum insufflation capacity is not recommended in patients with known structural abnormalities of the lungs or chronic obstructive airway disease. We report the case of a 72-year-old woman who had poliomyelitis as a child, developed torsion scoliosis and post-polio syndrome, and had periodic but infrequent asthma attacks. After performing air stacking for 3 years, the patient suddenly developed a pneumothorax, indicating that this technique should be used with caution or not at all in patients with a known pulmonary pathology

  14. Lung volumes during sustained microgravity on Spacelab SLS-1

    Science.gov (United States)

    Elliott, Ann R.; Prisk, G. Kim; Guy, Harold J. B.; West, John B.

    1994-01-01

    Gravity is known to influence the mechanical behavior of the lung and chest wall. However, the effect of sustained microgravity (microgravity) on lung volumes has not been reported. Pulmonary function tests were performed by four subjects before, during, and after 9 days of microgravity exposure. Ground measurements were made in standing and supine postures. Tests were performed using a bag-in-box-and-flowmeter system and a respiratory mass spectrometer. Measurements included functional residual capacity (FRC), expiratory reserve volume (ERV), residual volume (RV), inspiratory and expiratory vital capacities (IVC and EVC), and tidal volume (V9sub T)). Total lung capacity (TLC) was derived from the measured EVC and RV values. With preflight standing values as a comparison, FRC was significantly reduced by 15% (approximately 500 ml) in microgravity and 32% in the supine posture. ERV was reduced by 10 - 20% in microgravity and decreased by 64% in the supine posture. RV was significantly reduced by 18% (310 ml) in microgravity but did not significantly change in the supine posture compared with standing. IVC and EVC were slightly reduced during the first 24 h of microgravity but returned to 1-G standing values within 72 h of microgravity exposure. IVC and EVC in the supine posture were significantly reduced by 12% compared with standing. During microgravity, V(sub T) decreased by 15% (approximately 90 ml), but supine V(sub T) was unchanged compared with preflight standing values. TLC decreased by approximately 8% during microgravity and in the supine posture compared with preflight standing. The reductions in FRC, ERV, and RV during microgravity are probably due to the cranial shift of the diaphragm, an increase in intrathoracic blood volume, and more uniform alveolar expansion.

  15. Fibreoptic Bronchoscope for Nasogastric Tube Placement

    OpenAIRE

    Bhandari Dhiraj; Garg Deepika; Chandankhede Shweta; Sharma Vaijyanti; Premendran Benhur; Tidke Sucheta

    2015-01-01

    A patient of stage III squamous cell carcinoma of mandible with hemi-mandibulectomy, modified radical neck dissection and radiotherapy required Ryle’s Tube (RT) insertion for feeding. This case report describes use of fibreoptic bronchoscope to place an endotracheal tube in oesophagus through nasal route which was then used as a conduit to pass a RT into stomach.

  16. Fibreoptic Bronchoscope for Nasogastric Tube Placement

    Directory of Open Access Journals (Sweden)

    Bhandari Dhiraj

    2015-09-01

    Full Text Available A patient of stage III squamous cell carcinoma of mandible with hemi-mandibulectomy, modified radical neck dissection and radiotherapy required Ryle’s Tube (RT insertion for feeding. This case report describes use of fibreoptic bronchoscope to place an endotracheal tube in oesophagus through nasal route which was then used as a conduit to pass a RT into stomach.

  17. Multimodal 3D PET/CT system for bronchoscopic procedure planning

    Science.gov (United States)

    Cheirsilp, Ronnarit; Higgins, William E.

    2013-02-01

    Integrated positron emission tomography (PET) / computed-tomography (CT) scanners give 3D multimodal data sets of the chest. Such data sets offer the potential for more complete and specific identification of suspect lesions and lymph nodes for lung-cancer assessment. This in turn enables better planning of staging bronchoscopies. The richness of the data, however, makes the visualization and planning process difficult. We present an integrated multimodal 3D PET/CT system that enables efficient region identification and bronchoscopic procedure planning. The system first invokes a series of automated 3D image-processing methods that construct a 3D chest model. Next, the user interacts with a set of interactive multimodal graphical tools that facilitate procedure planning for specific regions of interest (ROIs): 1) an interactive region candidate list that enables efficient ROI viewing in all tools; 2) a virtual PET-CT bronchoscopy rendering with SUV quantitative visualization to give a "fly through" endoluminal view of prospective ROIs; 3) transverse, sagittal, coronal multi-planar reformatted (MPR) views of the raw CT, PET, and fused CT-PET data; and 4) interactive multimodal volume/surface rendering to give a 3D perspective of the anatomy and candidate ROIs. In addition the ROI selection process is driven by a semi-automatic multimodal method for region identification. In this way, the system provides both global and local information to facilitate more specific ROI identification and procedure planning. We present results to illustrate the system's function and performance.

  18. Lung Volume during Swallowing: Single Bolus Swallows in Healthy Young Adults

    Science.gov (United States)

    Hegland, Karen M. Wheeler; Huber, Jessica E.; Pitts, Teresa; Sapienza, Christine M.

    2009-01-01

    Purpose: This study examined the relationship between swallowing and lung volume initiation in healthy adults during single swallows of boluses differing in volume and consistency. Differences in lung volume according to respiratory phase surrounding the swallow were also assessed. Method: Nine men and 11 women between the ages of 19 and 28 years…

  19. Lung Volume during Swallowing: Single Bolus Swallows in Healthy Young Adults

    Science.gov (United States)

    Hegland, Karen M. Wheeler; Huber, Jessica E.; Pitts, Teresa; Sapienza, Christine M.

    2009-01-01

    Purpose: This study examined the relationship between swallowing and lung volume initiation in healthy adults during single swallows of boluses differing in volume and consistency. Differences in lung volume according to respiratory phase surrounding the swallow were also assessed. Method: Nine men and 11 women between the ages of 19 and 28 years…

  20. Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography

    Directory of Open Access Journals (Sweden)

    Dong Kyu Lee

    2014-01-01

    Conclusion: Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.

  1. Estimation of lung volume and pressure from electrocardiogram

    KAUST Repository

    Elsayed, Gamal Eldin Fathy Amin

    2011-05-01

    The Electrocardiography (ECG) is a tool measuring the electrical excitation of the heart that is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological processes. The respiratory activity is a prominent process that affects the ECG signal due to the close proximity of the heart and the lungs and, on the other hand, due to neural regulatory processes. In this paper, several means for the estimation of the respiratory process from the ECG signal are presented. The results show a strong correlation of the voltage difference between the R and S peak of the ECG and the lung\\'s volume and pressure. Correlation was also found for some features of the vector ECG, which is a two dimensional graph of two different ECG signals. The potential benefit of the multiparametric evaluation of the ECG signal is a reduction of the number of sensors connected to patients, which will increase the patients\\' comfort and reduce the costs associated with healthcare. In particular, it is relevant for sleep monitoring, where a reduction of the number of different sensors would facilitate a more natural sleeping environment and hence a higher sensitivity of the diagnosis. © 2011 IEEE.

  2. Time for the Global Rollout of Endoscopic Lung Volume Reduction.

    Science.gov (United States)

    Koegelenberg, Coenraad F N; Slebos, Dirk-Jan; Shah, Pallav L; Theron, Johan; Dheda, Keertan; Allwood, Brian W; Herth, Felix J F

    2015-01-01

    Chronic obstructive pulmonary disease remains one of the most common causes of morbidity and mortality globally. The disease is generally managed with pharmacotherapy, as well as guidance about smoking cessation and pulmonary rehabilitation. Endoscopic lung volume reduction (ELVR) has been proposed for the treatment of advanced emphysema, with the aim of obtaining the same clinical and functional advantages of surgical lung volume reduction whilst potentially reducing risks and costs. There is a growing body of evidence that certain well-defined sub-groups of patients with advanced emphysema may benefit from ELVR, provided the selection criteria are met and a systematic approach is followed. ELVR devices, particularly unidirectional valves and coils, are currently being rolled out to many countries outside of the U.S.A. and Europe, although very few centres currently have the capacity to correctly evaluate and provide ELVR to prospective candidates. The high cost of these interventions underpins the need for careful patient selection to best identify those who may or may not benefit from ELVR-related procedures. The aim of this review is to provide the practicing pulmonologist with an overview of the practical aspects and current evidence for the use of the various techniques available, and to suggest an evidence-based approach for the appropriate use of these devices, particularly in emerging markets, where there should be a drive to develop and equip key specialised ELVR units.

  3. Maternal smoking and fetal lung volume-an in utero MRI investigation.

    Science.gov (United States)

    Schmid, Maximilian; Kasprian, Gregor; Marschalek, Julian; Posch, Angela; Balassy, Csilla; Prayer, Daniela

    2011-05-01

    To investigate whether fetal lung volume and fetal lung volume growth over gestation are different in mothers who reported smoking during pregnancy compared to non-smoking controls. Cross-sectional retrospective study of the data of 200 consecutive singleton pregnancies that underwent magnetic resonance imaging (MRI). Fetal lung volumes of 32 fetuses of mothers who reported smoking during pregnancy were compared to 168 fetuses of non-smoking controls. Cases reported smoking between 2 and 30 cigarettes per day. The mean number of cigarettes per day for cases was 10.2 ± 6.1. After logarithmic transformation, lung volumes showed a linear increase with gestational age (r(2) = 0.7). Multiple regression analysis revealed a significant influence of gestational age (p < 0.0001) but not maternal smoking status (p = 1.0) on fetal lung volumes. Comparison of the relative difference between observed and predicted lung volumes for both groups by means of unpaired t-test revealed no significant influence of maternal smoking status on this variable (p = 0.9). Fetuses of mothers who reported smoking during pregnancy show similar lung volumes and lung volume growth in MRI compared to non-smoking controls. Our data suggest that a reduced lung volume is not responsible for the increase in respiratory symptoms associated with prenatal smoking. Copyright © 2011 John Wiley & Sons, Ltd.

  4. Fetal cardiac disease and fetal lung volume: an in utero MRI investigation.

    Science.gov (United States)

    Mlczoch, Elisabeth; Schmidt, Lisa; Schmid, Maximilian; Kasprian, Gregor; Frantal, Sophie; Berger-Kulemann, Vanessa; Prayer, Daniela; Michel-Behnke, Ina; Salzer-Muhar, Ulrike

    2014-03-01

    Magnetic resonance imaging (MRI) is a powerful, noninvasive tool to study fetal lung volumes after 18 weeks of gestation in vivo. In neonates with congenital heart disease (CHD), proper lung function is essential for postnatal survival. Antenatal detection of abnormal pulmonary development may help to optimize prenatal and perinatal management of at-risk fetuses. We aimed to investigate lung volumes in fetuses with prenatally diagnosed heart disease. A cross-sectional, retrospective study of 105 consecutive singleton pregnancies with CHD and a control, non-CHD group (n = 115), that underwent fetal MRI was performed. The heart defects detected were divided into four groups. Lung volumes of fetuses with heart disease were compared with control, non-CHD fetuses. In addition, z-scores of lung volumes were calculated for the CHD group (normal range z-scores from -2-+2). As a group, fetuses with CHD have significantly smaller lung volumes compared with control fetuses when corrected by gestational age (GA) (p = 0.049). Of the 105 CHD fetuses studied, 18 had lung volumes with a z-score < -2. Fetuses with different types of CHD showed similar lung volumes. Our data indicate that postpartum pulmonary symptoms and outcome in neonates with congenital heart disease may be attributed to the cardiac disease itself and in part to smaller lung volumes. © 2013 John Wiley & Sons, Ltd.

  5. Pressure-volume characteristics of lungs of rats during pregnancy and postpartum.

    Science.gov (United States)

    Faridy, E E

    1981-01-01

    Measurements of lung volumes in pregnant women show that the functional residual capacity and residual volume are reduced by 17-25% at late pregnancy. The present study was conducted to test the hypothesis that a decrease in FRC at pregnancy may result from an increase in retractive forces of the lung. The air and saline pressure-volume characteristics of excised lungs were studied in rats daily during pregnancy and the postpartum period. In comparison to non-pregnancy rats, the air PV measurements indicated that: (1) the retractive forces of the lungs were increased late in pregnancy resulting in reduction in both MLV (lung air volume at 40 cm H2O Ptp) and in V%10 (volume at 10/volume at 40 cm H2O Ptp X 100); (2) MLV was greater in lactating than in non-lactating and in non-pregnant rats. Lung saline volume was also greater in lactating than in non-lactating rats at early postpartum period. Lung phospholipids content was increased at late pregnancy and in lactating rats; (3) there was an increase in MLV and in V% immediately after delivery and 2-3 days after an abrupt cessation of lactation ("dried" rats). The minimal surface tension of lung lavages also decreased in these rats. A shift to that left of the air PV curve in "dried" rats suggest that under normal circumstances lung surface forces are not at their lowest.

  6. Mediastinal staging for lung cancer: the influence of biopsy volume

    DEFF Research Database (Denmark)

    Nelson, Elof; Pape, Christian; Jørgensen, Ole Dan

    2010-01-01

    OBJECTIVE: Mediastinal staging is of paramount importance prior to surgery for non-small-cell lung cancer (NSCLC) to identify patients with N2-disease. Mediastinoscopy remains the gold standard, and sampling from at least three lymph node stations is generally recommended. It is unknown whether...... of demonstrating N2-disease (psampling from several lymph node stations was significantly associated with a decreased probability of demonstrating N2-disease (p=0.015) and volume was significantly larger per station when fewer stations were sampled (p... nodes during mediastinoscopy was significantly associated with the probability of demonstrating N2-disease; however, contrary to common belief, sampling from several lymph node stations was not associated with an increased probability of detecting N2-disease. Although purely speculative, these findings...

  7. The flexible bronchoscope damages in a teaching bronchoscopy unit

    Directory of Open Access Journals (Sweden)

    Štefan Duh

    2007-10-01

    Full Text Available Background: Bronchoscopic procedures are associated with costs for purchasing and maintaining the equipment. Significant share of bronchoscopy unit budget represent costs of repairs for damaged bronchoscopes which are supposedly higher in the teaching centers. The purpose of the study was to determine frequency, sort and cause of bronchoscope damages as well as costs of repair.Methods: We retrospectively studied frequency, sort, cause and repair costs of bronchoscope damages for 13 new bronchoscopes, which were introduced in a program between August 1, 2001 and December 31, 2006.Results: We registered 47 bronchoscope damages during the study, which represents 1 damage per 141.6 procedures. 6 (12.7 % damages were potentially preventable with more careful approach. The most frequent wear and tear injury was rubber sheath injury on the distal bending portion of flexible bronchoscope and the most frequent preventable injury was the damage of the working channel of the bronchoscope. Repair costs amounted to 34,950.00 EUR, which means 5.25 EUR per procedure. We could spare mostly 17,781.00 EUR with more attentive work. Application of the bronchoscopes for educational purposes was not associated with higher rate of bronchoscope damages at our institution.Conclusions: Repair costs represent a significant share of bronchoscopy unit budget. We demonstrated that only a smaller number of bronchoscope damages in our unit are potentially preventable, but they still represent an important amount of expenses. Relatively small share of preventable damages during regular program and teaching procedures is attributable to a good bronchoscopy training programme, which is attended future bronchoscopists in our institution.

  8. Effects of obesity on lung volume and capacity in children and adolescents: a systematic review

    Directory of Open Access Journals (Sweden)

    Aline Dill Winck

    Full Text Available Abstract Objective: To assess the effects of obesity on lung volume and capacity in children and adolescents. Data source: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. Data synthesis: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. Conclusions: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.

  9. Effects of obesity on lung volume and capacity in children and adolescents: a systematic review

    Science.gov (United States)

    Winck, Aline Dill; Heinzmann-Filho, João Paulo; Soares, Rafaela Borges; da Silva, Juliana Severo; Woszezenki, Cristhiele Taís; Zanatta, Letiane Bueno

    2016-01-01

    Abstract Objective: To assess the effects of obesity on lung volume and capacity in children and adolescents. Data source: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. Data synthesis: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. Conclusions: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume. PMID:27130483

  10. BRONCHOSCOPIC THERAPY IN PATIENTS WITH INTRALUMINAL TYPICAL BRONCHIAL CARCINOID

    NARCIS (Netherlands)

    SUTEDJA, TG; SCHREURS, AJ; VANDERSCHUEREN, RG; KWA, B; VANDERWERF, TS; POSTMUS, PE

    1995-01-01

    Objective: To study the efficacy of bronchoscopic therapy in patients with intraluminal typical bronchial carcinoid. Design: Retrospective analysis of the data of patients with bronchial carcinoid, treated primarily with bronchoscopic techniques such as Nd-YAG laser in various hospitals in the Nethe

  11. Volume adjustment of lung density by computed tomography scans in patients with emphysema

    DEFF Research Database (Denmark)

    Shaker, S B; Dirksen, A; Laursen, Lars Christian

    2004-01-01

    package that detected the lung in contiguous images and subsequently generated a histogram of the pixel attenuation values. The total lung volume (TLV), lung weight, percentile density (PD), and relative area of emphysema (RA) were calculated from this histogram. RA and PD are commonly applied measures......PURPOSE: To determine how to adjust lung density measurements for the volume of the lung calculated from computed tomography (CT) scans in patients with emphysema. MATERIAL AND METHODS: Fifty patients with emphysema underwent 3 CT scans at 2-week intervals. The scans were analyzed with a software...... of pulmonary emphysema derived from CT scans. These parameters are markedly influenced by changes in the level of inspiration. The variability of lung density due to within-subject variation in TLV was explored by plotting TLV against PD and RA. RESULTS: The coefficients for volume adjustment for PD were...

  12. Quantitative measurement of regional lung gas volume by synchrotron radiation computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Monfraix, Sylvie [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Bayat, Sam [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Porra, Liisa [Department of Physical Sciences, University of Helsinki, POB 64, FIN-00014 Helsinki (Finland); Berruyer, Gilles [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Nemoz, Christian [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Thomlinson, William [Canadian Light Source, 101 Perimeter Road, Saskatoon, SK S7N 0X4 (Canada); Suortti, Pekka [Department of Physical Sciences, University of Helsinki, POB 64, FIN-00014 Helsinki (Finland); Sovijaervi, Anssi R A [Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, POB 340, FIN-00029 HUS, Helsinki (Finland)

    2005-01-07

    The aim of this study was to assess the feasibility of a novel respiration-gated spiral synchrotron radiation computed tomography (SRCT) technique for direct quantification of absolute regional lung volumes, using stable xenon (Xe) gas as an inhaled indicator. Spiral SRCT with K-edge subtraction using two monochromatic x-ray beams was used to visualize and directly quantify inhaled Xe concentrations and airspace volumes in three-dimensional (3D) reconstructed lung images. Volume measurements were validated using a hollow Xe-filled phantom. Spiral images spanning 49 mm in lung height were acquired following 60 breaths of an 80% Xe-20% O{sub 2} gas mixture, in two anaesthetized and mechanically ventilated rabbits at baseline and after histamine aerosol inhalation. Volumetric images of 20 mm lung sections were obtained at functional residual capacity (FRC) and at end-inspiration. 3D images showed large patchy filling defects in peripheral airways and alveoli following histamine provocation. Local specific lung compliance was calculated based on FRC/end-inspiration images in normal lung. This study demonstrates spiral SRCT as a new technique for direct determination of regional lung volume, offering possibilities for non-invasive investigation of regional lung function and mechanics, with a uniquely high spatial resolution. An example of non-uniform volume distribution in rabbit lung following histamine inhalation is presented.

  13. Lung volume reduction surgery: an overview Cirurgia redutora de volume pulmonar: uma revisão

    Directory of Open Access Journals (Sweden)

    Rodrigo Afonso da Silva Sardenberg

    2010-01-01

    Full Text Available This study intends to review the literature on the efficacy, safety and feasibility of lung volume reduction surgery (LVRS in patients with advanced emphysema. Studies on LVRS from January 1995 to December 2009 were included by using Pubmed (MEDLINE and Cochrane Library literature in English. Search words such as lung volume reduction surgery or lung reduction surgery, pneumoplasty or reduction pneumoplasty, COPD or chronic obstructive pulmonary disease and surgery, were used. We also compared medical therapy and surgical technique. Studies consisting of randomized controlled trials, controlled clinical trials (randomized and nonrandomized, reviews and case series were analyzed. Questions regarding validity of the early clinical reports, incomplete follow-up bias, selection criteria and survival, confounded the interpretation of clinical data on LVRS. Patients with upper, lower and diffuse distribution of emphysema were included; we also analyzed as key points perioperative morbidity and mortality and lung function measurement as FEV1. Bullous emphysema was excluded from this review. Surgical approach included median sternotomy, unilateral or bilateral thoracotomy, and videothoracoscopy with stapled or laser ablation. Results of prospective randomized trials between medical management and LVRS are essential before final assessment can be established.O objetivo deste estudo é revisar a literatura acerca da eficácia, segurança e viabilidade da cirurgia redutora de volume pulmonar (CRVP em pacientes com enfisema pulmonar avançado. Estudos de CRVP de janeiro de 1995 a dezembro de 2009 foram incluídos através de pesquisa na Pubmed (MEDLINE e Cochrane Library, na literatura inglesa. Palavras de busca tais como lung volume reduction surgery ou lung reduction surgery, pneumoplasty ou reduction pneumoplasty, COPD ou chronic obstructive pulmonary disease e surgery foram utilizadas. Também realizamos comparação entre terapia médica e cir

  14. A pseudoepidemic of Mycobacterium chelonae infection caused by contamination of a fibreoptic bronchoscope suction channel.

    Science.gov (United States)

    Wang, H C; Liaw, Y S; Yang, P C; Kuo, S H; Luh, K T

    1995-08-01

    An unusual increase in the frequency of isolation of Mycobacterium chelonae subspecies chelonae from specimens of bronchial washings was found between September and December 1992 in National Taiwan University Hospital. During this period, a total of 123 patients underwent fibreoptic bronchoscopy with an Olympus P20. Seventy six patients had bronchial washing for bacteriological study and cytological examination. Acid-fast bacilli were found in 21 patients, in 18 of whom Mycobacterium chelonae were isolated from bronchial washing cultures. Eight patients were treated as mycobacterial infected, because of the presence of unexplained pulmonary lesion, positive acid-fast stain and culture for Mycobacterium chelonae. Diagnosis of lung cancer was delayed in one patient because of the initial negative cytological study and positive bacterial culture. The fibreoptic bronchoscope was disinfected by automated washing machine (EW-20, Olympus) using 2.3% glutaraldehyde according to a standard protocol. From a survey to search for possible sources of contamination, they were identified at the suction channel of four different bronchoscopes. This episode proved to be a pseudoepidemic. The contamination was controlled by extensive suction and rinsing of the channel with 70% alcohol immediately after disinfection by the automated bronchoscope disinfection machine. This study shows that, despite using the disinfection machine, the suction channel could still be contaminated with Mycobacterium chelonae. This may cause diagnostic confusion and unnecessary antimycobacterial treatment.

  15. Evaluation of Neonatal Lung Volume Growth by Pulmonary Magnetic Resonance Imaging in Patients with Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Schopper, Melissa A; Walkup, Laura L; Tkach, Jean A; Higano, Nara S; Lim, Foong Yen; Haberman, Beth; Woods, Jason C; Kingma, Paul S

    2017-09-01

    To evaluate postnatal lung volume in infants with congenital diaphragmatic hernia (CDH) and determine if a compensatory increase in lung volume occurs during the postnatal period. Using a novel pulmonary magnetic resonance imaging method for imaging neonatal lungs, the postnatal lung volumes in infants with CDH were determined and compared with prenatal lung volumes obtained via late gestation magnetic resonance imaging. Infants with left-sided CDH (2 mild, 9 moderate, and 1 severe) were evaluated. The total lung volume increased in all infants, with the contralateral lung increasing faster than the ipsilateral lung (mean ± SD: 4.9 ± 3.0 mL/week vs 3.4 ± 2.1 mL/week, P = .005). In contrast to prenatal studies, the volume of lungs of infants with more severe CDH grew faster than the lungs of infants with more mild CDH (Spearman's ρ=-0.086, P = .01). Although the contralateral lung volume grew faster in both mild and moderate groups, the majority of total lung volume growth in moderate CDH came from increased volume of the ipsilateral lung (42% of total lung volume increase in the moderate group vs 32% of total lung volume increase in the mild group, P = .09). Analysis of multiple clinical variables suggests that increased weight gain was associated with increased compensatory ipsilateral lung volume growth (ρ = 0.57, P = .05). These results suggest a potential for postnatal catch-up growth in infants with pulmonary hypoplasia and suggest that weight gain may increase the volume growth of the more severely affected lung. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Volume calculation of CT lung lesions based on Halton low-discrepancy sequences

    Science.gov (United States)

    Li, Shusheng; Wang, Liansheng; Li, Shuo

    2017-03-01

    Volume calculation from the Computed Tomography (CT) lung lesions data is a significant parameter for clinical diagnosis. The volume is widely used to assess the severity of the lung nodules and track its progression, however, the accuracy and efficiency of previous studies are not well achieved for clinical uses. It remains to be a challenging task due to its tight attachment to the lung wall, inhomogeneous background noises and large variations in sizes and shape. In this paper, we employ Halton low-discrepancy sequences to calculate the volume of the lung lesions. The proposed method directly compute the volume without the procedure of three-dimension (3D) model reconstruction and surface triangulation, which significantly improves the efficiency and reduces the complexity. The main steps of the proposed method are: (1) generate a certain number of random points in each slice using Halton low-discrepancy sequences and calculate the lesion area of each slice through the proportion; (2) obtain the volume by integrating the areas in the sagittal direction. In order to evaluate our proposed method, the experiments were conducted on the sufficient data sets with different size of lung lesions. With the uniform distribution of random points, our proposed method achieves more accurate results compared with other methods, which demonstrates the robustness and accuracy for the volume calculation of CT lung lesions. In addition, our proposed method is easy to follow and can be extensively applied to other applications, e.g., volume calculation of liver tumor, atrial wall aneurysm, etc.

  17. Lung volumes related to physical activity, physical fitness, aerobic capacity and body mass index in students

    Directory of Open Access Journals (Sweden)

    Mihailova A.

    2016-01-01

    Reduced lung volumes were associated with lower aerobic fitness, lower physical fitness and lower amount of weekly physical activity. Healthier body mass index was associated with higher aerobic fitness (relative VO2max in both female and male.

  18. Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency

    Directory of Open Access Journals (Sweden)

    Danny Lee, PhD

    2017-07-01

    Conclusions: This study demonstrated that audiovisual biofeedback can be used to improve the reproducibility and consistency of breath-hold lung tumor position and volume, respectively. These results may provide a pathway to achieve more accurate lung cancer radiation treatment in addition to improving various medical imaging and treatments by using breath-hold procedures.

  19. High procedure volume is strongly associated with improved survival after lung cancer surgery

    DEFF Research Database (Denmark)

    Lüchtenborg, Margreet; Riaz, Sharma P; Coupland, Victoria H

    2013-01-01

    Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect.......Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect....

  20. Severe Emphysema Treated by Endoscopic Bronchial Volume Reduction with Lung Sealant (AeriSeal

    Directory of Open Access Journals (Sweden)

    R. F. Falkenstern-Ge

    2013-01-01

    Full Text Available Endoscopic lung volume reduction using lung sealant is a very new and innovative treatment option for patients with severe progressive and irreversible lung emphysema. A 55-year-old ex-smoker (60 pack years referred to our center because of severe lung emphysema with progressive worsening of the obstructive ventilator pattern and clinical condition. We detected collateral channels of this patient by using the Chartis system. Therefore, we decided to treat the advanced emphysema of our patient with endoscopic volume reduction using lung sealant (AeriSeal. The foam of lung sealant AeriSeal is instilled into the peripheral airways and alveoli where it polymerizes and functions as tissue glue on the lung surface in order to seal the target region to cause durable irreversible absorption atelectasis. The follow-up evaluation 12 weeks later showed improved lung function (increased FEV 1/partial oxygen pressure/peripheral oxygen saturation and a reduction of TLC and RV with improved quality of life. Correlation between changes in primary and secondary outcome measures in the lung function parameters and 6-minute-walking test before and 12 weeks after the application of lung sealant revealed significant reduction of hyperinflation and improvement both in the flow rates and in the physical capability of this patient.

  1. Automatic segmentation of tumor-laden lung volumes from the LIDC database

    Science.gov (United States)

    O'Dell, Walter G.

    2012-03-01

    The segmentation of the lung parenchyma is often a critical pre-processing step prior to application of computer-aided detection of lung nodules. Segmentation of the lung volume can dramatically decrease computation time and reduce the number of false positive detections by excluding from consideration extra-pulmonary tissue. However, while many algorithms are capable of adequately segmenting the healthy lung, none have been demonstrated to work reliably well on tumor-laden lungs. Of particular challenge is to preserve tumorous masses attached to the chest wall, mediastinum or major vessels. In this role, lung volume segmentation comprises an important computational step that can adversely affect the performance of the overall CAD algorithm. An automated lung volume segmentation algorithm has been developed with the goals to maximally exclude extra-pulmonary tissue while retaining all true nodules. The algorithm comprises a series of tasks including intensity thresholding, 2-D and 3-D morphological operations, 2-D and 3-D floodfilling, and snake-based clipping of nodules attached to the chest wall. It features the ability to (1) exclude trachea and bowels, (2) snip large attached nodules using snakes, (3) snip small attached nodules using dilation, (4) preserve large masses fully internal to lung volume, (5) account for basal aspects of the lung where in a 2-D slice the lower sections appear to be disconnected from main lung, and (6) achieve separation of the right and left hemi-lungs. The algorithm was developed and trained to on the first 100 datasets of the LIDC image database.

  2. Dynamic measures of regional lung air volume using phase contrast x-ray imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kitchen, M J; Lewis, R A; Morgan, M J; Siu, K K W; Habib, A [School of Physics, Monash University, Melbourne VIC 3800 (Australia); Wallace, M J; Siew, M L; Hooper, S B [Department of Physiology, Monash University, Melbourne VIC 3800 (Australia); Fouras, A [Division of Biological Engineering, Monash University, Melbourne VIC 3800 (Australia); Yagi, N; Uesugi, K [SPring-8/JASRI, Sayo, Hyogo 679-5198 (Japan)], E-mail: Marcus.Kitchen@sci.monash.edu.au

    2008-11-07

    Phase contrast x-ray imaging can provide detailed images of lung morphology with sufficient spatial resolution to observe the terminal airways (alveoli). We demonstrate that quantitative functional and anatomical imaging of lung ventilation can be achieved in vivo using two-dimensional phase contrast x-ray images with high contrast and spatial resolution (<100 {mu}m) in near real time. Changes in lung air volume as small as 25 {mu}L were calculated from the images of term and preterm rabbit pup lungs (n = 28) using a single-image phase retrieval algorithm. Comparisons with plethysmography and computed tomography showed that the technique provided an accurate and robust method of measuring total lung air volumes. Furthermore, regional ventilation was measured by partitioning the phase contrast images, which revealed differences in aeration for different ventilation strategies.

  3. Bronchoscopic Management of Airway Obstruction in Pediatric Endobronchial Tuberculosis

    Directory of Open Access Journals (Sweden)

    Jeff SW Wong

    2006-01-01

    Full Text Available The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.

  4. Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion.

    Science.gov (United States)

    DiBardino, David M; Lanfranco, Anthony R; Haas, Andrew R

    2016-08-01

    Cryotherapy is an evolving therapeutic and diagnostic tool used during bronchoscopy. Through rapid freeze-thaw cycles, cryotherapy causes cell death and tissue necrosis or tissue adherence that can be used via the flexible or rigid bronchoscope. This extreme cold can be used through the working channel of the bronchoscope via a specialized cryoprobe or directly with the use of spray cryotherapy. These properties allow for multiple bronchoscopic techniques, each with its own equipment and procedural, safety, and efficacy considerations. Bronchoscopic cryotherapy can be used in a variety of clinical scenarios, including the treatment of malignant and benign central airway obstruction and low-grade airway malignancy, foreign body removal or cryoextraction, endobronchial biopsy, and transbronchial biopsy. The bulk of the experience with bronchoscopic cryotherapy consists of uncontrolled case series of malignant central airway obstruction. There are also controlled data supporting the use of cryoadhesion for endobronchial biopsies, albeit with an increased risk of controllable bleeding. The use of cryoadhesion for transbronchial biopsies is an active area of investigation with limited controlled data. In addition, there are promising future directions using bronchoscopic cryotherapy, including chemosensitizing malignancy with cryotherapy and capitalizing on the synergy between cryotherapy and radiation.

  5. Fetal lung volume measurement by MRI with high-speed imaging systems

    Energy Technology Data Exchange (ETDEWEB)

    Osada, Hisao; Kaku, Kenshi [Chiba Univ. (Japan). Hospital

    2002-08-01

    Although ultrasonography is widely used for fetal morphologic observation, magnetic resonance imaging (MRI) has gained popularity as a new prenatal diagnostic method with recent introduction of high-speed imaging systems. Infants with lung hypoplasia affecting respiratory function require intensive management starting immediately after birth. Therefore, accurate prenatal differential diagnosis and severity evaluation are extremely important for these fetuses. The aim of this study is to measure fetal lung volume using a computer-based, three-dimensional MRI imaging system and to evaluate the possibility of clinical applications of this procedure. A total of 96 fetuses were evaluated, all were morphologically abnormal, and MRI was done for advanced assessment from 24 to 39 weeks gestation. Three-directional views of fetal chest were imaged by Signa Horizon, 1.5 Tesla, version 5.6 (General Electronics) with the following conditions; coil: TORSO coil, sequence: SSFSE (single shot fast spin echo), slice thickness: 5 mm, and imaging speed: 2 seconds/slice. To calculate the lung volume and create three-dimensional image, the lung area in each slice was traced out, then multiplied using computer image processing. Simultaneously, the volumes of all slices were summed to give the volume of each lung. Linear regression analysis and analysis of covariance (ANCOVA) were used for statistical analyses. In all cases, clear images were obtained, and were adequate for three-dimensional evaluation of the fetal lung. Thirty-five fetuses had poor outcomes, such as intrauterine fetal death, neonatal death, and intensive respiratory care. Regression lines of lung volume versus gestational week were calculated for these fetuses with poor outcome and 61 other fetuses with good outcome. ANCOVA, with gestational week as a covariant, revealed a significant intergroup difference in the lung volume (p<0.001). Similarly, regression lines of lung volume versus fetal body weight estimated by

  6. Reference Equations for Static Lung Volumes and TLCO from a Population Sample in Northern Greece.

    Science.gov (United States)

    Michailopoulos, Pavlos; Kontakiotis, Theodoros; Spyratos, Dionisios; Argyropoulou-Pataka, Paraskevi; Sichletidis, Lazaros

    2015-02-14

    Background: The most commonly used reference equations for the measurement of static lung volumes/capacities and transfer factor of the lung for CO (TLCO) are based on studies around 30-40 years old with significant limitations. Objectives: Our aim was to (1) develop reference equations for static lung volumes and TLCO using the current American Thoracic Society/European Respiratory Society guidelines, and (2) compare the equations derived with those most commonly used. Methods: Healthy Caucasian subjects (234 males and 233 females) aged 18-91 years were recruited. All of them were healthy never smokers with a normal chest X-ray. Static lung volumes and TLCO were measured with a single-breath technique according to the latest guidelines. Results: Curvilinear regression prediction equations derived from the present study were compared with those that are most commonly used. Our reference equations in accordance with the latest studies show lower values for all static lung volume parameters and TLCO as well as a different way of deviation of those parameters (i.e. declining with age total lung capacity, TLCO age decline in both sex and functional residual capacity age rise in males). Conclusions: We suggest that old reference values of static lung volumes and TLCO should be updated, and our perception of deviation of some spirometric parameters should be revised. Our new reference curvilinear equations derived according to the latest guidelines could contribute to the updating by respiratory societies of old existing reference values and result in a better estimation of the lung function of contemporary populations with similar Caucasian characteristics. © 2015 S. Karger AG, Basel.

  7. Physiological Modeling of Responses to Upper vs Lower Lobe Lung Volume Reduction in Homogeneous Emphysema

    Directory of Open Access Journals (Sweden)

    Arschang eValipour

    2012-10-01

    Full Text Available Rationale: In clinical trials, homogeneous emphysema patients have responded well to upper lobe volume reduction but not lower lobe volume reduction. Materials/Methods: To understand the physiological basis for this observation, a computer model was developed to simulate the effects of upper and lower lobe lung volume reduction on RV/TLC and lung recoil in homogeneous emphysema.Results: Patients with homogeneous emphysema received either upper or lower lobe volume reduction therapy based on findings of radionucleotide scintigraphy scanning. CT analysis of lobar volumes showed that patients undergoing upper (n=18; -265 mL/site and lower lobe treatment (n=11; -217 mL/site experienced similar reductions in lung volume. However, only upper lobe treatment improved FEV1 (+11.1±14.7% vs -4.4±15.8% and RV/TLC (-5.4± 8.1% vs -2.4±8.6%. Model simulations provided an unexpected explanation for this response. Increases in transpulmonary pressure subsequent to volume reduction increased RV/TLC in upper lobe alveoli, while caudal shifts in airway closure decreased RV/TLC in lower lobe alveoli. Upper lobe treatment, which eliminates apical alveoli with high RV/TLC values, lowers the average RV/TLC of the lung. Conversely, lower lobe treatment, which eliminates caudal alveoli with low RV/TLC values, has less effect. Conclusions: Lower lobe treatment in homogeneous emphysema is uniformly less effective than upper lobe treatment.

  8. Development and proof-of-concept of three-dimensional lung histology volumes

    Science.gov (United States)

    Mathew, Lindsay; Alabousi, Mostafa; Wheatley, Andrew; Aladl, Usaf; Slipetz, Deborah; Hogg, James C.; Fenster, Aaron; Parraga, Grace

    2012-03-01

    Most medical imaging is inherently three-dimensional (3D) but for validation of pathological findings, histopathology is commonly used and typically histopathology images are acquired as twodimensional slices with quantitative analysis performed in a single dimension. Histopathology is invasive, labour-intensive, and the analysis cannot be performed in real time, yet it remains the gold standard for the pathological diagnosis and validation of clinical or radiological diagnoses of disease. A major goal worldwide is to improve medical imaging resolution, sensitivity and specificity to better guide therapy and biopsy and to one day delay or replace biopsy. A key limitation however is the lack of tools to directly compare 3D macroscopic imaging acquired in patients with histopathology findings, typically provided in a single dimension (1D) or in two dimensions (2D). To directly address this, we developed methods for 2D histology slice visualization/registration to generate 3D volumes and quantified tissue components in the 3D volume for direct comparison to volumetric micro-CT and clinical CT. We used the elastase-instilled mouse emphysema lung model to evaluate our methods with murine lungs sectioned (5 μm thickness/10 μm gap) and digitized with 2μm in-plane resolution. 3D volumes were generated for wildtype and elastase mouse lung sections after semi-automated registration of all tissue slices. The 1D mean linear intercept (Lm) for wildtype (WT) (47.1 μm +/- 9.8 μm) and elastase mouse lung (64.5 μm +/- 14.0 μm) was significantly different (p<.001). We also generated 3D measurements based on tissue and airspace morphometry from the 3D volumes and all of these were significantly different (p<.0001) when comparing elastase and WT mouse lung. The ratio of the airspace-to-lung volume for the entire lung volume was also significantly and strongly correlated with Lm.

  9. Entropy Production and the Pressure-Volume Curve of the Lung

    Directory of Open Access Journals (Sweden)

    Cláudio Lucas Oliveira

    2016-03-01

    Full Text Available We investigate analytically the production of entropy during a breathing cycle in healthy and diseased lungs. First, we calculate entropy production in healthy lungs by applying the laws of thermodynamics to the well-known transpulmonary pressure-volume (P-V curves of the lung under the assumption that lung tissue behaves as an entropy spring-like rubber. The bulk modulus, $B$, of the lung is also derived from these calculations. Second, we extend this approach to elastic recoil disorders of the lung such as occur in pulmonary fibrosis and emphysema. These diseases are characterized by particular alterations in the P-V relationship. For example, in fibrotic lungs B increases monotonically with disease progression, while in emphysema the opposite occurs. These diseases can thus be mimicked simply by making appropriate adjustments to the parameters of the P-V curve. Using Clausius's formalism, we show that entropy production, Delta_S, is related to the hysteresis area, Delta_A, enclosed by the P-V curve during a breathing cycle, namely, Delta_S = Delta_A/T, where T is the body temperature. Although Delta_A is highly dependent on the disease, such formula applies to healthy as well as diseased lungs, regardless of the disease stage. Finally, we use ansatzs to predict analytically the entropy produced by the fibrotic and emphysematous lungs.

  10. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

    Science.gov (United States)

    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at the Clinic for pulmonary diseases “Podhrastovi” in the period from 01.06.2012. to 01.06.2014. The following resections were done: pulmectomy (left, right), lobectomy (upper, lower: left and right). The values of postoperative pulmonary function were compared with preoperative ones. As a parameter of lung function we used FEV1 (forced expiratory volume in one second), and changes in FEV1 are expressed in liters and in percentage of the recorded preoperative and normal values of FEV1. Measurements of lung function were performed seven days before and 2 months after surgery. Results: Postoperative FEV1 was decreased compared to preoperative values. After pulmectomy the maximum reduction of FEV1 was 44%, and after lobectomy it was 22% of the preoperative values. Conclusion: Patients with airway obstruction are limited in their daily life before the surgery, and an additional loss of lung tissue after resection contributes to their inability. Potential benefits of lung resection surgery should be balanced in relation to postoperative morbidity and mortality. PMID:25568542

  11. Experimental study of acute lung injury induced by different tidal volume ventilation in rats

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin-ri; DU Yong-cheng; JIANG Hong-ying; XU Jian-ying; XU Yong-jian

    2005-01-01

    @@ Mechanical ventilation (MV) is a dual blade sward which if misused could lead to lung injury, called ventilator induced lung injury (VILI). Pathogenesis of VILI is very complex with various manifestations, which is the focus in MV field in recent years.1 In our research, the rats were ventilated with different tidal volume, then the pathological changes of the lungs were observed under macroscopy, light and electronic microscope, and various laboratory tests in blood and bronchoalveolar lavage fluid (BALF) were also carried out in order to probe further the pathologic characteristics and the pathogenesis of VILI.

  12. Bronchoscopic foreign body extraction in a pulmonary medicine department: a retrospective review of egyptian experience.

    Science.gov (United States)

    Korraa, Emad; Madkour, Ashraf; Wagieh, Khaled; Nafae, Ahmed

    2010-01-01

    Foreign body (FB) removal in our hospital was almost exclusively performed by surgeons through a rigid bronchoscope until the pulmonologists started getting involved in FB extraction. This study aimed to retrospectively review the results of 2 years of experience with 120 patients who presented or were referred to the Pulmonary Medicine Department, Ain Shams University Hospital in Cairo, Egypt, with clinical suspicion of FB aspiration during the period between December 2006 and December 2008. FBs were removed by either rigid and/or flexible bronchoscopy using either general or topical anesthesia. There were 54 male and 66 female patients with an age range between 3 months and 70 years and 68.5% of the patients were under the age of 10 years. Ninety patients (75%) presented with a definite history of FB aspiration, with a time interval between aspiration and presentation ranging between less than 6 hours and 12 months. The FB was visible on the chest x-ray in 42 cases. Aspirations were primarily into the right lung (53.2%). Seeds and scarf pins were the most common FB found, and were retrieved in 36 cases. Pulmonologists were successful in extracting 110 out of 111 (99.1%) bronchoscopically visualized FBs, and open thoracotomy was required in only 1 case for FB removal. In another 6 cases, only mucous plug was found to be the endogenous FB, whereas no FB could be found in 3 cases. No mortality or serious complications took place during or after the bronchoscopy. In conclusion, pulmonologists can extract FBs easily and safely either by using rigid and/or flexible bronchoscopes if they have the appropriate experience.

  13. Modulation of chest wall intermuscular coherence: effects of lung volume excursion and transcranial direct current stimulation.

    Science.gov (United States)

    Tomczak, Corey R; Greidanus, Krista R; Boliek, Carol A

    2013-08-01

    Chest wall muscle recruitment varies as a function of the breathing task performed. However, the cortical control of the chest wall muscles during different breathing tasks is not known. We studied chest wall intermuscular coherence during various task-related lung volume excursions in 10 healthy adults (34 ± 15 yr; 2 men, 8 women) and determined if transcranial direct current stimulation (tDCS) could modulate chest wall intermuscular coherence during these tasks. Simultaneous assessment of regional intercostal and oblique electromyographic activity was measured while participants performed standardized tidal breathing, speech, maximum phonation, and vital capacity tasks. Lung volume and chest wall kinematics were determined using variable inductance plethysmography. We found that chest wall area of intermuscular coherence was greater during tidal and speech breathing compared with phonation and vital capacity (all P < 0.05) and between tidal breathing compared with speech breathing (P < 0.05). Anodal tDCS increased chest wall area of intermuscular coherence from 0.04 ± 0.09 prestimulation to 0.18 ± 0.19 poststimulation for vital capacity (P < 0.05). Sham tDCS and cathodal tDCS had no effect on coherence during lung volume excursions. Chest wall kinematics were not affected by tDCS. Our findings indicate that lung volume excursions about the midrange of vital capacity elicit a greater area of chest wall intermuscular coherence compared with lung volume excursions spanning the entire range of vital capacity in healthy adults. Our findings also demonstrate that brief tDCS may modulate the cortical control of the chest wall muscles in a stimulation- and lung volume excursion task-dependent manner but does not affect chest wall kinematics in healthy adults.

  14. Relationship between costovertebral joint kinematics and lung volume in supine humans.

    Science.gov (United States)

    Beyer, Benoît; Van Sint Jan, Serge; Chèze, Laurence; Sholukha, Victor; Feipel, Véronique

    2016-10-01

    This study investigates the relationship between the motion of the first ten costovertebral joints (CVJ) and lung volume over the inspiratory capacity (IC) using detailed kinematic analysis in a sample of 12 asymptomatic subjects. Retrospective codified spiral-CT data obtained at total lung capacity (TLC), middle of inspiratory capacity (MIC) and at functional residual capacity (FRC) were analysed. CVJ 3D kinematics were processed using previously-published methods. We tested the influence of the side, CVJ level and lung volume on CVJ kinematics. In addition, the correlations between anthropologic/pulmonary variables and CVJ kinematics were analysed. No linear correlation was found between lung volumes and CVJ kinematics. Major findings concerning 3D kinematics can be summarized as follows: 1) Ranges-of-motion decrease gradually with increasing CVJ level; 2) rib displacements are significantly reduced at lung volumes above the MIC and do not differ between CVJ levels; 3) the axes of rotation of the ribs are similarly oriented for all CVJ levels.

  15. Heimlich's maneuver-assisted bronchoscopic removal of airway foreign body.

    Science.gov (United States)

    Solanki, Sohan Lal; Bansal, Shivendu; Khare, Arvind; Jain, Amit

    2011-01-01

    Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In the present case, a 5-year-old child was presented with history of FB aspiration 5 h back. After multiple failed bronchoscopic attempts to remove the FB it was decided to use Heimlich maneuver in the supine position. A single attempt of Heimlich maneuver expelled the FB into the oral cavity, which was removed by Magill's forceps. On repeated bronchoscope check, there was no remnant of FB. Child's further course of stay in hospital was uneventful. In conclusion, Heimlich maneuver may be useful in patient with failed bronchoscope removal of airway FBs before proceeding for tracheotomy or other invasive procedures.

  16. Prognostic value of tumor volume for patients with advanced lung cancer treated with chemotherapy.

    Science.gov (United States)

    Kuo, Chung-Feng Jeffrey; Ke, Bo-Han; Wu, Nain-Ying; Kuo, Joseph; Hsu, Hsian-He

    2017-06-01

    We aim to develop a reference system utilizing computed tomography to calculate changes in tumor volume of lung cancer patients after chemotherapy to assist physicians in clinical treatment and evaluation. Image processing techniques were used to analyze the computed tomography of lung cancer, locate the tumor, and calculate the tumor volume. The medical indicator was then evaluated and analyzed. We examined the correlation between reduced tumor volume and survival duration of 88 patients after chemotherapy at Tri-Service General Hospital, Taiwan. The innovative survival prediction index was obtained by four statistical methods: receiver operating characteristic curve, Youden index, Kaplan-Meier method, and log rank test. From the image processing techniques, tumor volume from each patient were obtained within an average of 7.25 seconds. The proposed method was shown to achieve rapid positioning of lung tumors and volume reconstruction with an estimation error of 1.92% when calibrated with an irregularly shaped stone. In medical indicator evaluation and analysis, the area below the receiver operating characteristic curve is greater than 0.8, indicating good predictability of the medical index used herein. The Youden index spotted the best cut-off point of volume, and the correlation between the volume's cut-off point and survival time was confirmed again by Kaplan-Meier and log rank test. The p-values were all less than 0.05, presenting a high degree of correlation between the two, indicating that this medical indicator is highly reliable. The proposed techniques can automatically find the location of tumors in the lung, reconstruct the volume, and calculate changes in volume before and after treatment, thus obtaining an innovative survival prediction index. This will help facilitate early and accurate predictions of disease outcomes during the course of therapy, and categorize patient stratification into risk groups for more efficient therapies. Copyright © 2017

  17. Evaluation of dose-volume histogram parameters (V20 and mean dose) in lung cancer adaptive radiotherapy with design of composite lung volumes (ITV; Evaluacion de parametros del histograma dosis-volumen (V20 y dosis media) en radioterapia adaptada de cancer de pulmon con diseno de volumenes pulmonares compuestos (Internal Target Volume, ITV)

    Energy Technology Data Exchange (ETDEWEB)

    Monroy Anton, J. L.; Solar Tortosa, M.; Lopez Munoz, M.; Navarro Bergada, A.; Estornell gualde, M. A.; Melchor Iniguez, M.

    2013-07-01

    Physiological respiratory motion is a challenge in external radiotherapy for lung tumors. In adaptive radiotherapy, changing position of the target volume should be reflected in the simulation procedure and taken into account in the design of volumes for CTV/PTV proper coverage. This may be achieved through the design of an Internal Target Volume (ITV) as indicated in ICRU-62. However, the Dose-Volume Histogram (DVH) evaluation of the doses received by the healthy lung may vary in the case of designing a single lung volume, compared to the composite lung volume obtained with the fusion of normal breathing, inspiration and expiration (ITV{sub l}ung). (Author)

  18. The relationships between tracheal index and lung volume parameters in mild-to-moderate COPD

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Jung Seop, E-mail: ejs00@hanmail.net [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Lee, Geewon, E-mail: rabkingdom@naver.com [Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739 (Korea, Republic of); Lee, Ho Yun, E-mail: hoyunlee96@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Oh, Jin Young, E-mail: indr71@hanmail.net [Division of Pulmonology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, 814 Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773 (Korea, Republic of); Woo, Sook-young, E-mail: sookyoung12.woo@samsung.com [Biostatistics Team, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Jeon, Kyeongman, E-mail: kjeon@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Um, Sang-Won, E-mail: sangwonum@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Koh, Won-Jung, E-mail: wjkoh@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Suh, Gee Young, E-mail: suhgy@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); and others

    2013-12-01

    Background: Although elongated morphological changes in the trachea are known to be related to lung function in chronic obstructive pulmonary disease (COPD), whether the tracheal morphological changes are associated with airflow limitations or overinflation of the lung in the early stages of COPD has not yet been determined. Thus, our aim was to investigate the association of tracheal index (TI) with lung function parameters, including lung volume parameters, in COPD patients with mild-to-moderate airflow limitations. Materials and methods: A retrospective study was conducted in 193 COPD patients with GOLD grades 1–2 (post-bronchodilator forced expiratory volume in 1 s [FEV{sub 1}] ≥ 50% predicted with FEV{sub 1}/forced vital capacity ratio ≤ 70%; age range, 40–81) and 193 age- and gender-matched subjects with normal lung function as a control group (age range, 40–82). Two independent observers measured TI at three anatomical levels on chest radiographs and CT scans. Results: Compared with the control group, TI was reduced significantly and “saber-sheath trachea” was observed more frequently in COPD patients. Patients with GOLD grade 2 disease had a lower TI than those with GOLD grade 1. TI had apparent inverse correlations with total lung capacity, functional residual capacity, and residual volume, regardless of the anatomical level of the trachea. Even after adjustments for covariates, this association persisted. Conclusions: TI is reduced even in mild-to-moderate COPD patients, and TI measured on chest CT shows significant inverse relationships with all lung volume parameters assessed, suggesting that tracheal morphology may change during the early stages of COPD.

  19. Phase contrast imaging reveals low lung volumes and surface areas in the developing marsupial.

    Directory of Open Access Journals (Sweden)

    Shannon J Simpson

    Full Text Available Marsupials are born with immature lungs when compared to eutherian mammals and rely, to various extents, on cutaneous gas exchange in order to meet metabolic requirements. Indeed, the fat-tailed dunnart is born with lungs in the canalicular stage of development and relies almost entirely on the skin for gas exchange at birth; consequently undergoing the majority of lung development in air. Plane radiographs and computed tomography data sets were acquired using phase contrast imaging with a synchrotron radiation source for two marsupial species, the fat-tailed dunnart and the larger tammar wallaby, during the first weeks of postnatal life. Phase contrast imaging revealed that only two lung sacs contain air after the first hour of life in the fat-tailed dunnart. While the lung of the tammar wallaby was comparatively more developed, both species demonstrated massive increases in air sac number and architectural complexity during the postnatal period. In addition, both the tammar wallaby and fat-tailed dunnart had lower lung volumes and parenchymal surface areas than were expected from morphometrically determined allometric equations relating these variables to body mass during the neonatal period. However, lung volume is predicted to scale with mass as expected after the neonatal marsupial reaches a body mass of ∼1 g and no longer relies on the skin for gas exchange. Decreased lung volume in the marsupial neonate further supports the maxim that cutaneous gas exchange occurs in the marsupial neonate because the respiratory apparatus is not yet capable of meeting the gas exchange requirements of the newborn.

  20. Structural and functional changes in the minipig lung following irradiation of different lung volumes at a constant mean lung dose; Strukturelle und funktionelle Veraenderungen an der Lunge von Minischweinen nach Bestrahlung unterschiedlich grosser Lungenvolumina mit gleicher mittlerer Lungendosis

    Energy Technology Data Exchange (ETDEWEB)

    Kusche, S.; Herrmann, T.; Appold, S.; Hoelscher, T.; Bruechner, K.; Geyer, P.; Baumann, M.; Kumpf, R.

    2004-07-01

    Minipigs were subjected to irradiation of different lung volumes at approximately the same mean lung dose (D{sub m}ean) and examined for structural and morphological changes of the lung. The outcome confirmed earlier findings on the pig lung. While no significant differences between irradiation groups was found in terms of functional lung changes, there was a clear correlation between functional changes observed and the mean lung dose. This is in good agreement with data from clinical studies. It follows that the mean lung dose is of predictive value in considering functional lung damage in the assessment of different irradiation regimes. By contrast structural damage was found to correlate with applied dose. [German] Es wurden an Minischweinen unterschiedliche grosse Lungenvolumina mit vergleichbaren mittleren Lungendosen (mean lung dose, D{sub mean}) bestrahlt und die funktionellen und morphologischen Veraenderungen bestimmt. Die Untersuchungen zu funktionellen und morphologischen Veaenderungen bestaetigen fruehere Untersuchungen an der Schweinelunge. Hinsichtlich funktioneller Lungenveraenderungen fand sich kein signifikanter Unterschied zwischen den Bestrahlungsarmen, aber es konnte eine eindeutige Korrelation dieser Veraenderungen mit der mittleren Lungendosis D{sub mean} nachgewiesen werden. Dies steht in gutem Einklang mit Daten aus klinischen Untersuchungen. Somit bestaetigt sich, dass die mean lung dose eine praediktive Bedeutung zur Abschaetzung funktionaler Schaeden der Lunge bei der Beurteilung unterschiedlicher Bestrahlungsplaene hat. Die strukturellen Schaeden korrelieren hingegen mit der applizierten Dosis. (orig.)

  1. Dynamic volume perfusion CT in patients with lung cancer: Baseline perfusion characteristics of different histological subtypes

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Jingyun, E-mail: shijingyun89179@126.com [Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine (China); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Schmid-Bindert, Gerald, E-mail: gerald.schmid-bindert@medma.uni-heidelberg.de [Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Fink, Christian, E-mail: Christian.Fink@akh-celle.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Sudarski, Sonja, E-mail: sonja_sudarski@gmx.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@medma.uni-heidelberg.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Pilz, Lothar R., E-mail: Lothar.Pilz@medma.uni-heidelberg.de [Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1, 68167 Mannheim (Germany); Liu, Bo, E-mail: bo.liu@siemens.com [Siemens Healthcare, No. 278, Zhouzhu Road, Shanghai, 201318 (China); Haberland, Ulrike, E-mail: ulrike.haberland@siemens.com [Siemens Healthcare Sector, H IM CR R and D PA SC, Siemensstraße 1, 91301 Forchheim (Germany); Klotz, Ernst, E-mail: ernst.klotz@siemens.com [Siemens Healthcare Sector, H IM CR R and D PA SC, Siemensstraße 1, 91301 Forchheim (Germany); and others

    2013-12-01

    Objective: To evaluate dynamic volume perfusion CT (dVPCT) tumor baseline characteristics of three different subtypes of lung cancer in untreated patients. Materials and methods: 173 consecutive patients (131 men, 42 women; mean age 61 ± 10 years) with newly diagnosed lung cancer underwent dVPCT prior to biopsy. Tumor permeability, blood flow (BF), blood volume (BV) and mean transit time (MTT) were quantitatively assessed as well as tumor diameter and volume. Tumor subtypes were histologically determined and compared concerning their dVPCT results. dVPCT results were correlated to tumor diameter and volume. Results: Histology revealed adenocarcinoma in 88, squamous cell carcinoma in 54 and small cell lung cancer (SCLC) in 31 patients. Tumor permeability was significantly differing between adenocarcinoma, squamous cell carcinoma and SCLC (all p < 0.05). Tumor BF and BV were higher in adenocarcinomathan in SCLC (p = 0.001 and p = 0.0002 respectively). BV was also higher in squamous cell carcinoma compared to SCLC (p = 0.01). MTT was not differing between tumor subtypes. Regarding all tumors, tumor diameter did not correlate with any of the dVPCT parameters, whereas tumor volume was negatively associated with permeability, BF and BV (r = −0.22, −0.24, −0.24, all p < 0.05). In squamous cell carcinoma, tumor diameter und volume correlated with BV (r = 0.53 and r = −0.40, all p < 0.05). In SCLC, tumor diameter und volume correlated with MTT (r = 0.46 and r = 0.39, all p < 0.05). In adenocarcinoma, no association between morphological and functional tumor characteristics was observed. Conclusions: dVPCT parameters are only partially related to tumor diameter and volume and are significantly differing between lung cancer subtypes.

  2. Tumor Volume-Adapted Dosing in Stereotactic Ablative Radiotherapy of Lung Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Trakul, Nicholas; Chang, Christine N.; Harris, Jeremy [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Chapman, Christopher [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of Michigan School of Medicine, Ann Arbor, MI (United States); Rao, Aarti [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Davis, School of Medicine, Davis, CA (United States); Shen, John [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Irvine, School of Medicine, Irvine, CA (United States); Quinlan-Davidson, Sean [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario (Canada); Filion, Edith J. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Departement de Medecine, Service de Radio-Oncologie, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Wakelee, Heather A.; Colevas, A. Dimitrios [Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); Whyte, Richard I. [Department of Cardiothoracic Surgery, Division of General Thoracic Surgery, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); and others

    2012-09-01

    Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18-25 Gy) (Group 1), and larger tumors (gross tumor volume {>=}12 mL) received multifraction regimens with BED {>=}100 Gy (total dose, 50-60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

  3. Inspiratory and expiratory computed tomographic volumetry for lung volume reduction surgery.

    Science.gov (United States)

    Morimura, Yuki; Chen, Fengshi; Sonobe, Makoto; Date, Hiroshi

    2013-06-01

    Three-dimensional (3D) computed tomographic (CT) volumetry has been introduced into the field of thoracic surgery, and a combination of inspiratory and expiratory 3D-CT volumetry provides useful data on regional pulmonary function as well as the volume of individual lung lobes. We report herein a case of a 62-year-old man with severe emphysema who had undergone lung volume reduction surgery (LVRS) to assess this technique as a tool for the evaluation of regional lung function and volume before and after LVRS. His postoperative pulmonary function was maintained in good condition despite a gradual slight decrease 2 years after LVRS. This trend was also confirmed by a combination of inspiratory and expiratory 3D-CT volumetry. We confirm that a combination of inspiratory and expiratory 3D-CT volumetry might be effective for the preoperative assessment of LVRS in order to determine the amount of lung tissue to be resected as well as for postoperative evaluation. This novel technique could, therefore, be used more widely to assess local lung function.

  4. The feasibility of CT lung volume as a surrogate marker of donor-recipient size matching in lung transplantation.

    Science.gov (United States)

    Jung, Woo Sang; Haam, Seokjin; Shin, Jae Min; Han, Kyunghwa; Park, Chul Hwan; Byun, Min Kwang; Chang, Yoon Soo; Kim, Hyung Jung; Kim, Tae Hoon

    2016-07-01

    Donor-recipient size matching in lung transplantation (LTx) by computed tomography lung volume (CTvol) may be a reasonable approach because size matching is an anatomical issue. The purpose of this study is to evaluate the feasibility of CTvol as a surrogate marker of size matching in LTx by comparing CTvol and predicted total lung capacity (pTLC) to reference total lung capacity (TLC) values.From January to December 2014, data from 400 patients who underwent plethysmography, pulmonary function testing (PFT), and chest computed tomography scans were reviewed retrospectively. Enrolled 264 patients were divided into 3 groups according to PFT results: Group I, obstructive pattern; Group II, restrictive pattern; Group III, normal range. The correlations between pTLC and TLC and between CTvol and TLC were analyzed, and the linear correlation coefficients were compared. The percentage error rates of pTLC and CTvol were calculated and absolute error rates were compared.The correlation coefficient between CTvol and TLC in Group I was larger than that of pTLC and TLC (0.701 vs 0.432, P = 0.002). The absolute percentage error rate between CTvol and pTLC was lower than that of pTLC in Group II (15.3% ± 11.9% vs 42.2% ± 28.1%, P matching in LTx.

  5. Normal Expiratory Flow Rate and Lung Volumes in Patients with Combined Emphysema and Interstitial Lung Disease: A Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Karen L Heathcote

    2011-01-01

    Full Text Available Pulmonary function tests in patients with idiopathic pulmonary fibrosis characteristically show a restrictive pattern including small lung volumes and increased expiratory flow rates resulting from a reduction in pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. When the diseases coexist, pulmonary volumes are compensated, and a smaller than expected reduction or even normal lung volumes can be found. The present report describes 10 patients with progressive breathlessness, three of whom experienced severe limitation in their quality of life. All patients showed lung interstitial involvement and emphysema on computed tomography scan of the chest. The 10 patients showed normal spirometry and lung volumes with severe compromise of gas exchange. Normal lung volumes do not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.

  6. A STUDY ON SPIROMETRIC EVALUATION OF LUNG VOLUME RESTRICTION IN PREDIAGNOSED CASES OF SKELETAL FLUOROSIS

    Directory of Open Access Journals (Sweden)

    Abhijit

    2014-07-01

    Full Text Available Fluorosis is an important public health problem in India. Skeletal changes and mottled enamel may result when drinking water contains excess fluoride. Due to involvement of ribcage skeletal fluorosis causes restrictive lung disease causing reduction in vital capacity. This cross sectional observational study has been done on 55 pre diagnosed patients of skeletal fluorosis, they have been classified according to MMRC dyspnea grading & lung volume has been measured. Among 55 patients, 43 patients (78.18% have shortness of breath, it also has been seen that 13.95% patients have MMRC grade 4 dyspnea, i.e. too breathless to leave the home & 21.81% of cases have FVC < 34% of predicted, i.e. very severe lung volume restriction.

  7. Heimlich's maneuver-assisted bronchoscopic removal of airway foreign body

    OpenAIRE

    Solanki, Sohan Lal; Bansal, Shivendu; Khare, Arvind; Jain, Amit

    2011-01-01

    Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In ...

  8. Mechanisms controlling the volume of pleural fluid and extravascular lung water

    Directory of Open Access Journals (Sweden)

    G. Miserocchi

    2009-12-01

    Full Text Available Pleural and interstitial lung fluid volumes are strictly controlled and maintained at the minimum thanks to the ability of lymphatics to match the increase in filtration rate. In the pleural cavity, fluid accumulation is easily accommodated by retraction of lung and chest wall (high compliance of the pleural space; the increase of lymph flow per unit increase in pleural fluid volume is high due to the great extension of the parietal lymphatic. However, for the lung interstitium, the increase in lymph flow to match increased filtration does not need to be so great. In fact, increased filtration only causes a minor increase in extravascular water volume (<10% due to a marked increase in interstitial pulmonary pressure (low compliance of the extracellular matrix which, in turn, buffers further filtration. Accordingly, a less extended lymphatic network is needed. The efficiency of lymphatic control is achieved through a high lymphatic conductance in the pleural fluid and through a low interstitial compliance for the lung interstitium. Fluid volume in both compartments is so strictly controlled that it is difficult to detect initial deviations from the physiological state; thus, a great physiological advantage turns to be a disadvantage on a clinical basis as it prevents an early diagnosis of developing disease.

  9. Volume controlled fixation of the lung by formalin vapor. Pt. 1

    Energy Technology Data Exchange (ETDEWEB)

    Rau, W.S.; Mittermayer, C.

    1980-09-01

    A new method of lung fixation by formalin vapor is presented. A simple Engstrom type respirator modified for postmortem formalin insufflation of the lung was developed. Rapid fixation requires use of hot formalin vapor which would destroy available equipment. The main advantage compared to other described methods beside the constant volume is sufficient stirring of formalin and formalin vapor. In order to prevent condensation of water within the lung parenchyma any cooling of the vapor should be avoided. If the lungs are fixed by this method the tissue will stiffen in a position between in- and exspiration. Slices of 1 cm are cut. Radiographs in soft tissue technique guarantee unusual high resolution. Positive findings are identified easily and furthermore studied by microscopy: the direct correlation between X-ray finding and microscopy becomes possible.

  10. Study of limiting dosimetric parameters on lung pathology. Differences in the use of the lung-gtv and lung-ptv volumes; Estudio de los parametros dosimetricos limitantes en la patologia de pulmon diferencias en ul uso de los volumenes pulmon-gtv y pulmo-ptv

    Energy Technology Data Exchange (ETDEWEB)

    Granero Cabanero, D.; Almendros Blanco, P.; Garcia Hernanez, T.; Vicedo gonzalez, A.; Brualla, L.; Hernandez, A.; Solera, C.; Serrano, A.; Rosello, J.

    2013-07-01

    The objective of this work is to study the differences between the use of the volume of lung-GTV and lung-PTV to assess pulmonary toxicity and also to study the relationships between parameters V13, V20, V30, and mean dose of volumes lung, lung-PTV and lung-GTV. It was studied also the possible relationship between volumes of GTV, PTV and volume of lung with the dosimetric parameters described above. (Author)

  11. Entropy Production and the Pressure-Volume Curve of the Lung

    CERN Document Server

    Oliveira, Cláudio L N; Bates, Jason H T; Andrade, José S; Suki, Béla

    2015-01-01

    We investigate analytically the production of entropy during a breathing cycle in healthy and diseased lungs. First, we calculate entropy production in healthy lungs by applying the laws of thermodynamics to the well-known transpulmonary pressure-volume ($P-V$) curves of the lung under the assumption that lung tissue behaves as an entropy spring-like rubber. The bulk modulus, $B$, of the lung is also derived from these calculations. Second, we extend this approach to elastic recoil disorders of the lung such as occur in pulmonary fibrosis and emphysema. These diseases are characterized by particular alterations in the $P-V$ relationship. For example, in fibrotic lungs $B$ increases monotonically with disease progression, while in emphysema the opposite occurs. These diseases can thus be mimicked simply by making appropriate adjustments to the parameters of the $P-V$ curve. Using Clausius's formalism, we show that entropy production, $\\Delta S$, is related to the hysteresis area, $\\Delta A$, enclosed by the $P...

  12. Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry

    Science.gov (United States)

    Schultz, Kenia; D'Aquino, Luiz Carlos; Soares, Maria Raquel; Gimenez, Andrea; Pereira, Carlos Alberto de Castro

    2016-01-01

    ABSTRACT Objective: Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. Methods: This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% < 50% of predicted, together with a high RV/TLC ratio. Nonspecific lung disease (NLD) was characterized by TLC within the predicted range and no obstruction. Combined lung disease (CLD) was characterized by reduced TLC and findings indicative of airflow obstruction. Clinical diagnoses were based on clinical suspicion, a respiratory questionnaire, and the review of tests of interest. Results: We included 300 patients in the study, of whom 108 (36%) were diagnosed with RLD. In addition, 120 (40%) and 72 (24%) were diagnosed with OLD/CLD and NLD, respectively. Among the latter, 24 (33%) were clinically diagnosed with OLD. In this sample, 151 patients (50.3%) were obese, and obesity was associated with all patterns of lung disease. Conclusions: Measuring lung volumes and airway resistance is often necessary in order to provide an appropriate characterization of the pattern of lung disease in patients presenting with a spirometry pattern suggestive of restriction. Airflow obstruction is common in such cases. PMID:27812633

  13. Expression and Significance of NapsinA, TTF-1, CK5/6, CK7 and P63 in Biopsy Specimen by Bronchoscope of Non-small Cell Lung Cancer%NapsinA、TTF-1、CK5/6、CK7、P63在非小细胞肺癌支气管镜活检标本中的表达及意义

    Institute of Scientific and Technical Information of China (English)

    金夏祥; 俞国冰; 王爱忠; 邬丹钰; 唐晓兰

    2013-01-01

    目的 检测NapsinA、TTF-1、CK5/6、CK7及P63在非小细胞肺癌(NSCLC)支气管镜活检标本中的表达及意义.方法 采用免疫组织化学SP法检测47例NSCLC支气管镜活检标本中NapsinA、TTF-1、CK5/6、CK7及P63的表达,并结合NSCLC的临床特征病理进行分析.结果 NapsinA、TTF 1和CK7在27例肺腺癌中的阳性表达率分别为100%(27/27)、100%(27/27)和93%(25/27),表达水平明显高于CK5/6[19%(5/27)]和P63[0(0/27)](P<0.05);而CK5/6和P63在18例肺鳞癌中的阳性率均为100%(18/18),表达水平明显高于NapsinA及TTF 1[0(0/18)、0(0/18)]和CK7[11%(2/18)](P<0.05),两者差异均具有统计学意义.结论 NapsinA、TTF-1、CK7、CK5/6及P63在肺支气管镜活检标本腺癌和鳞癌鉴别诊断中具有重要意义.%Objective To detect the expression and significance of NapsinA,TTF-1 ,CK5/6.CK7 and P63 in biopsy specimen by bronchoscope of non-small cell lung cancer(NSCLC). Methods The expressions of NapsinA,TTF-l 、CK5/6、CK7 and P63 were detected by immunohistoehemical SP method in 47 NSCLC of biopsy specimen by bronchoscope,and the clinicalpathological features of NSCLC were analyzed statis tically. Results The positive rates of NapsinA. TTF-1 and CK7 were 100% (27/27), 100% (27/27) and 93%(25/27) in 27 cases of lung adenocarcinoma.respectively which was higher than CK5/6 19%(5/27) and P63 0(0/25) (P<0. 05) .respectively. The positive rates of CK5/6 and P63 were all 100% (18/1 8) in 18 cases of lung squamous cell carcinoma,respectively which was higher than NapsinA 0(0/18) , TTF-1 0 (0/18) and CK7 11 % (2/18) ( P<0. 05), respectively. Both showed significant increasing gradient. Con clusion NapsinA,TTF-1 ,CK5/6,CK7 and P63 expressions are important significance at the differential diagnosis between lung squamous cell carcinoma and adnocarcinoma in biopsy specimen by ' sonchoscope.

  14. Pulmonary blood volume and transit time in cirrhosis: relation to lung function

    DEFF Research Database (Denmark)

    Møller, Søren; Burchardt, H; Øgard, CG;

    2006-01-01

    not been determined separately we assessed PBV and pulmonary transit time (PTT) in relation to lung function in patients with cirrhosis and in controls. METHODS: Pulmonary and cardiac haemodynamics and transit times were determined by radionuclide techniques in 22 patients with alcoholic cirrhosis......BACKGROUND/AIMS: In cirrhosis a systemic vasodilatation leads to an abnormal distribution of the blood volume with a contracted central blood volume. In addition, the patients have a ventilation/perfusion imbalance with a low diffusing capacity. As the size of the pulmonary blood volume (PBV) has...... and in 12 controls. The lung function including diffusing capacity for carbon monoxide (DL, CO) was determined by conventional single breath technique. RESULTS: In the patients, PTT was shorter, 3.9+/-1.2 vs 5.7+/-1.0 s in the controls, P

  15. Pulmonary blood volume and transit time in cirrhosis: relation to lung function

    DEFF Research Database (Denmark)

    Møller, Søren; Burchardt, H; Øgard, CG

    2006-01-01

    BACKGROUND/AIMS: In cirrhosis a systemic vasodilatation leads to an abnormal distribution of the blood volume with a contracted central blood volume. In addition, the patients have a ventilation/perfusion imbalance with a low diffusing capacity. As the size of the pulmonary blood volume (PBV) has...... not been determined separately we assessed PBV and pulmonary transit time (PTT) in relation to lung function in patients with cirrhosis and in controls. METHODS: Pulmonary and cardiac haemodynamics and transit times were determined by radionuclide techniques in 22 patients with alcoholic cirrhosis...... and in 12 controls. The lung function including diffusing capacity for carbon monoxide (DL, CO) was determined by conventional single breath technique. RESULTS: In the patients, PTT was shorter, 3.9+/-1.2 vs 5.7+/-1.0 s in the controls, P

  16. Effect of low tidal volume ventilation on lung function and inflammation in mice

    Directory of Open Access Journals (Sweden)

    Goldmann Torsten

    2010-04-01

    Full Text Available Abstract Background A large number of studies have investigated the effects of high tidal volume ventilation in mouse models. In contrast data on very short term effects of low tidal volume ventilation are sparse. Therefore we investigated the functional and structural effects of low tidal volume ventilation in mice. Methods 38 Male C57/Bl6 mice were ventilated with different tidal volumes (Vt 5, 7, and 10 ml/kg without or with application of PEEP (2 cm H2O. Four spontaneously breathing animals served as controls. Oxygen saturation and pulse rate were monitored. Lung function was measured every 5 min for at least 30 min. Afterwards lungs were removed and histological sections were stained for measurement of infiltration with polymorphonuclear leukocytes (PMN. Moreover, mRNA expression of macrophage inflammatory protein (MIP-2 and tumor necrosis factor (TNFα in the lungs was quantified using real time PCR. Results Oxygen saturation did not change significantly over time of ventilation in all groups (P > 0.05. Pulse rate dropped in all groups without PEEP during mechanical ventilation. In contrast, in the groups with PEEP pulse rate increased over time. These effects were not statistically significant (P > 0.05. Tissue damping (G and tissue elastance (H were significantly increased in all groups after 30 min of ventilation (P 0.05. Mechanical ventilation significantly increased infiltration of the lungs with PMN (P Conclusions Our data show that very short term mechanical ventilation with lower tidal volumes than 10 ml/kg did not reduce inflammation additionally. Formation of atelectasis and inadequate oxygenation with very low tidal volumes may be important factors. Application of PEEP attenuated inflammation.

  17. Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation.

    Science.gov (United States)

    Lammi, Matthew R; Ciccolella, David; Marchetti, Nathaniel; Kohler, Malcolm; Criner, Gerard J

    2012-10-01

    Stroke volume augmentation during exercise is limited in chronic obstructive pulmonary disease patients because of decreased preload from dynamic hyperinflation (DH). We hypothesised that oxygen pulse and pulse pressure (PP) improve following lung volume reduction surgery (LVRS), and the magnitude of improvement correlates with reduction in DH. We compared 16 emphysema patients undergoing LVRS with six emphysema patients not undergoing LVRS. Oxygen pulse and PP were calculated from maximal cardiopulmonary exercise tests at baseline and 6 months. End-expiratory lung volume (EELV)/total lung capacity (TLC) represented DH. Comparisons were made between baseline and 6 months at metabolic isotimes (per cent maximal carbon dioxide production (V'(CO(2),max))). At baseline, the LVRS group was older with higher forced expiratory volume in 1 s, but had similar hyperinflation to the non-LVRS group. At 6 months, oxygen pulse (50%, 75%, and 100% V'(CO(2),max)) and PP (50% and 75% V'(CO(2),max)) increased in the LVRS, but not in the non-LVRS group. Baseline functional residual capacity/TLC inversely correlated with resting oxygen pulse (r= -0.449, p=0.04). Decreased EELV/TLC correlated with increased oxygen pulse at 75% (r= -0.487, p=0.02) and 100% V'(CO(2),max) (r= -0.548, p=0.008). LVRS led to increased oxygen pulse and PP during exercise at metabolic isotimes 6 months following surgery. Reductions in DH correlated with increases in oxygen pulse during exercise. Reducing lung volume may improve stroke volume response to exercise by decreasing DH.

  18. Hybrid bronchoscope tracking using a magnetic tracking sensor and image registration.

    Science.gov (United States)

    Mori, Kensaku; Deguchi, Daisuke; Akiyama, Kenta; Kitasaka, Takayuki; Maurer, Calvin R; Suenaga, Yasuhito; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi

    2005-01-01

    In this paper, we propose a hybrid method for tracking a bronchoscope that uses a combination of magnetic sensor tracking and image registration. The position of a magnetic sensor placed in the working channel of the bronchoscope is provided by a magnetic tracking system. Because of respiratory motion, the magnetic sensor provides only the approximate position and orientation of the bronchoscope in the coordinate system of a CT image acquired before the examination. The sensor position and orientation is used as the starting point for an intensity-based registration between real bronchoscopic video images and virtual bronchoscopic images generated from the CT image. The output transformation of the image registration process is the position and orientation of the bronchoscope in the CT image. We tested the proposed method using a bronchial phantom model. Virtual breathing motion was generated to simulate respiratory motion. The proposed hybrid method successfully tracked the bronchoscope at a rate of approximately 1 Hz.

  19. Lung volume, breathing pattern and ventilation inhomogeneity in preterm and term infants.

    Directory of Open Access Journals (Sweden)

    Philipp Latzin

    Full Text Available BACKGROUND: Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques. METHODOLOGY/PRINCIPAL FINDINGS: We studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg than preterm infants without BPD (23.4 mL/kg and term-born infants (22.6 mL/kg, though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (t(PTEF/t(E than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity. CONCLUSIONS: Our results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process.

  20. Comparison of the dose to lung volume between supine and prone position during treatment planning

    Institute of Scientific and Technical Information of China (English)

    Yu Li; Huijun Xu ; Sujing Zhang; Xiaoliang Liu

    2015-01-01

    Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi-tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and of er a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were se-lected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862–36337 MU more; the lung D5% was 5.20–7.90 Gy higher; and the lung D20% was 2.61–5.73 Gy higher. The dif erence of dose to spine volume between the two plans was –2.21–2.67 Gy; to the skin volume was –3.93–7.85 Gy; and to the esophagus was 0.28–6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the availability of beams.

  1. Changes in Stroke Volume Induced by Lung Recruitment Maneuver Predict Fluid Responsiveness in Mechanically Ventilated Patients in the Operating Room.

    Science.gov (United States)

    Biais, Matthieu; Lanchon, Romain; Sesay, Musa; Le Gall, Lisa; Pereira, Bruno; Futier, Emmanuel; Nouette-Gaulain, Karine

    2017-02-01

    Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r = 0.56; P recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.

  2. Expiratory flow limitation and operating lung volumes during exercise in older and younger adults.

    Science.gov (United States)

    Smith, Joshua R; Kurti, Stephanie P; Meskimen, Kayla; Harms, Craig A

    2017-02-20

    We determined the effect of aging on expiratory flow limitation (EFL) and operating lung volumes when matched for lung size. We hypothesized that older adults will exhibit greater EFL and increases in EELV during exercise compared to younger controls. Ten older (5M/5W; >60years old) and nineteen height-matched young adults (10M/9W) were recruited. Young adults were matched for%predicted forced vital capacity (FVC) (Y-matched%Pred FVC; n=10) and absolute FVC (Y-matched FVC; n=10). Tidal flow-volume loops were recorded during the incremental exercise test with maximal flow-volume loops measured pre- and post-exercise. Compared to younger controls, older adults exhibited more EFL at ventilations of 26, 35, 51, and 80L/min. The older group had higher end-inspiratory lung volume compared to Y-matched%Pred FVC group during submaximal ventilations. The older group increased EELV during exercise, while EELV stayed below resting in the Y-matched%Pred FVC group. These data suggest older adults exhibit more EFL and increase EELV earlier during exercise compared to younger adults.

  3. Expiratory computed tomographic techniques: a cause of a poor rate of change in lung volume.

    Science.gov (United States)

    Morikawa, Keiko; Okada, Fumito; Mori, Hiromu

    2015-01-01

    Ninety-nine patients (29 males and 70 females; mean age, 57.1 years; range, 22-81 years) were included in this study to evaluate the factors affecting smaller lung volume changes in expiratory high-resolution computed tomography performed to depict air trapping. All patients underwent inspiratory and expiratory chest thin-section CT examinations and pulmonary function tests. Air trapping on CT images was graded subjectively. All variables (age, sex, diagnosis, pulmonary function index, and air trapping score) were compared with the degree of change in lung volume between the inspiratory and expiratory CT examinations. The variables affecting a lower degree of volume change were vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), and the FEV1.0/FVC ratio. Bronchiolitis obliterans was the dominant diagnosis in patients with insufficient degrees of breath holding and in patients with negative air trapping scores despite an abnormal air trapping index. An insufficient degree of lung changes between inspiration and expiration on CT examinations represented bronchiolitis obliterans, which resulted in low FEV1.0 and FEV1.0/FVC values. Changes in the time gap from the announcement of exhalation and breath holding to the start of scanning most effectively indicated air trapping in patients with bronchiolar disorders.

  4. Evaluation of dose according to the volume and respiratory range during SBRT in lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Deuk Hee [Dept. of Radiation Oncology, Busan Paik Hospital, Inje University, Busan (Korea, Republic of); Park, Eun Tae; Kim, Jung Hoon; Kang, Se Seik [Dept. of Radiological Science, College of Health Sciences, Catholic University of Pusan, Busan (Korea, Republic of)

    2016-09-15

    Stereotactic body radiotherapy is effective technic in radiotherapy for low stage lung cancer. But lung cancer is affected by respiratory so accurately concentrate high dose to the target is very difficult. In this study, evaluated the target volume according to how to take the image. And evaluated the dose by photoluminescence glass dosimeter according to how to contour the volume and respiratory range. As a result, evaluated the 4D CT volume was 10.4 cm{sup 3} which was closest value of real size target. And in dose case is internal target volume dose was 10.82, 16.88, 21.90 Gy when prescribed dose was 10, 15, 20 Gy and it was the highest dose. Respiratory gated radiotherapy dose was more higher than internal target volume. But it made little difference by respiratory range. Therefore, when moving cancer treatment, acquiring image by 4D CT, contouring internal target volume and respiratory gated radiotherapy technic would be the best way.

  5. Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis.

    Science.gov (United States)

    Gupta, Nalini; Singh, Gurmeet C; Rana, Manoj K

    2015-01-01

    Diagnosis of pulmonary tuberculosis (TB) is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]). The records of patients diagnosed to have pulmonary TB, over a period of 1-year were evaluated. Patients with positive acid-fast bacilli (AFB) culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14) histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin-eosin and Ziehl-Neelsen staining. Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each). Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%). Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

  6. Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Nalini Gupta

    2015-01-01

    Full Text Available Background: Diagnosis of pulmonary tuberculosis (TB is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]. Materials and Methods: The records of patients diagnosed to have pulmonary TB, over a period of 1-year were evaluated. Patients with positive acid-fast bacilli (AFB culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14 histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin-eosin and Ziehl-Neelsen staining. Results: Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each. Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%. Conclusion: Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

  7. Use of body plethysmography to measure effect of bimaxillary orthognathic surgery on airway resistance and lung volumes.

    Science.gov (United States)

    Rezaeetalab, Fariba; Kazemian, Mozhgan; Vaezi, Touraj; Shaban, Barratollah

    2015-12-01

    Bimaxillary orthognathic surgery can cause changes to respiration and the airways. We used body plethysmography to evaluate its effect on airway resistance and lung volumes in 20 patients with class III malocclusions (8 men and 12 women, aged 17 - 32 years). Lung volumes (forced vital capacity; forced inspiratory volume/one second; forced expiratory volume/one second: forced vital capacity; peak expiratory flow; maximum expiratory flow 25-75; maximum inspiratory flow; total lung capacity; residual volume; residual volume:total lung capacity), and airway resistance were evaluated one week before, and six months after, operation. Bimaxillary operations to correct class III malocclusions significantly increased airway resistance, residual volume, total lung capacity, and residual volume:total lung capacity. Other variables also changed after operation but not significantly so. Orthognathic operations should be done with caution in patients who have pre-existing respiratory diseases. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Relation between trunk fat volume and reduction of total lung capacity in obese men.

    Science.gov (United States)

    Watson, R A; Pride, N B; Thomas, E Louise; Ind, P W; Bell, J D

    2012-01-01

    Reduction in total lung capacity (TLC) in obese men is associated with restricted expansion of the thoracic cavity at full inflation. We hypothesized that thoracic expansion was reduced by the load imposed by increased total trunk fat volume or its distribution. Using MRI, we measured internal and subcutaneous trunk fat and total abdominal and thoracic volumes at full inflation in 14 obese men [mean age: 52.4 yr, body mass index (BMI): 38.8 (range: 36-44) kg/m(2)] and 7 control men [mean age: 50.1 yr, BMI: 25.0 (range: 22-27.5) kg/m(2)]. TLC was measured by multibreath helium dilution and was restricted (fat volume was 16.65 (range: 12.6-21.8) liters in obese men and 6.98 (range: 3.0-10.8) liters in control men. Anthropometry and mean total trunk fat volumes were similar in OR men and obese men without restriction (the ON subgroup). Mean total intraabdominal volume was 9.41 liters in OR men and 11.15 liters in ON men. In obese men, reduced thoracic expansion at full inflation and restriction of TLC were not inversely related to a large volume of 1) intra-abdominal or total abdominal fat, 2) subcutaneous fat volume around the thorax, or 3) total trunk fat volume. In addition, trunk fat volumes in obese men were not inversely related to gas volume or estimated intrathoracic volume at supine functional residual capacity. In conclusion, this study failed to support the hypotheses that restriction of TLC or impaired expansion of the thorax at full inflation in middle-aged obese men was simply a consequence of a large abdominal volume or total trunk fat volume or its distribution.

  9. Quantitative assessment of irradiated lung volume and lung mass in breast cancer patients treated with tangential fields in combination with deep inspiration breath hold (DIBH)

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, Karin Sigrid [Univ. Clinic of Therapeutic Radiology and Oncology, Medical Univ. of Graz (Austria); Zurl, Brigitte; Stranzl, Heidi; Winkler, Peter

    2010-03-15

    Purpose: Comparison of the amount of irradiated lung tissue volume and mass in patients with breast cancer treated with an optimized tangential-field technique with and without a deep inspiration breath-hold (DIBH) technique and its impact on the normal-tissue complication probability (NTCP). Material and Methods: Computed tomography datasets of 60 patients in normal breathing (NB) and subsequently in DIBH were compared. With a Real-Time Position Management Respiratory Gating System (RPM), anteroposterior movement of the chest wall was monitored and a lower and upper threshold were defined. Ipsilateral lung and a restricted tangential region of the lung were delineated and the mean and maximum doses calculated. Irradiated lung tissue mass was computed based on density values. NTCP for lung was calculated using a modified Lyman-Kutcher-Burman (LKB) model. Results: Mean dose to the ipsilateral lung in DIBH versus NB was significantly reduced by 15%. Mean lung mass calculation in the restricted area receiving {<=} 20 Gy (M{sub 20}) was reduced by 17% in DIBH but associated with an increase in volume. NTCP showed an improvement in DIBH of 20%. The correlation of individual breathing amplitude with NTCP proved to be independent. Conclusion: The delineation of a restricted area provides the lung mass calculation in patients treated with tangential fields. DIBH reduces ipsilateral lung dose by inflation so that less tissue remains in the irradiated region and its efficiency is supported by a decrease of NTCP. (orig.)

  10. Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure.

    Science.gov (United States)

    Kim, Chul-Ho; Fuglestad, Matthew A; Richert, Maile L Ceridon; Shen, Win K; Johnson, Bruce D

    2014-10-01

    It is unclear how dynamic changes in pulmonary-capillary blood volume (Vc), alveolar lung volume (derived from end-inspiratory lung volume, EILV) and interstitial fluid (ratio of alveolar capillary membrane conductance and pulmonary capillary blood volume, Dm/Vc) influence lung impedance (Z(T)). The purpose of this study was to investigate if positional change and exercise result in increased EILV, Vc and/or lung interstitial fluid, and if Z(T) tracks these variables. 12 heart failure (HF) patients underwent measurements (Z(T), EILV, Vc/Dm) at rest in the upright and supine positions, during exercise and into recovery. Inspiratory capacity was obtained to provide consistent measures of EILV while assessing Z(T). Z(T) increased with lung volume during slow vital capacity maneuvers (p0.05). Impedance appears sensitive to changes in lung volume and body position which appear to generally overwhelm small acute changes in lung fluid when assed dynamically at rest or during exercise. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

    Institute of Scientific and Technical Information of China (English)

    TANG Yi-jun; WANG Chao-yang; WANG Cheng-de; DONG Yao-zhong

    2009-01-01

    Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery (LVRS) can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms.Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups.Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO_2, PaCO_2,dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B.Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded thesurgical indication for tumor patients.

  12. Reduction of total lung capacity in obese men: comparison of total intrathoracic and gas volumes.

    Science.gov (United States)

    Watson, R A; Pride, N B; Thomas, E Louise; Fitzpatrick, J; Durighel, G; McCarthy, J; Morin, S X; Ind, P W; Bell, J D

    2010-06-01

    Restriction of total lung capacity (TLC) is found in some obese subjects, but the mechanism is unclear. Two hypotheses are as follows: 1) increased abdominal volume prevents full descent of the diaphragm; and 2) increased intrathoracic fat reduces space for full lung expansion. We have measured total intrathoracic volume at full inflation using magnetic resonance imaging (MRI) in 14 asymptomatic obese men [mean age 52 yr, body mass index (BMI) 35-45 kg/m2] and 7 control men (mean age 50 yr, BMI 22-27 kg/m2). MRI volumes were compared with gas volumes at TLC. All measurements were made with subjects supine. Obese men had smaller functional residual capacity (FRC) and FRC-to-TLC ratio than control men. There was a 12% predicted difference in mean TLC between obese (84% predicted) and control men (96% predicted). In contrast, differences in total intrathoracic volume (MRI) at full inflation were only 4% predicted TLC (obese 116% predicted TLC, control 120% predicted TLC), because mediastinal volume was larger in obese than in control [heart and major vessels (obese 1.10 liter, control 0.87 liter, P=0.016) and intrathoracic fat (obese 0.68 liter, control 0.23 liter, P80% predicted (ON) was 26% predicted TLC. Mediastinal volume was similar in OR (1.84 liter) and ON (1.73 liter), but total intrathoracic volume was 19% predicted TLC smaller in OR than in ON. We conclude that the major factor restricting TLC in some obese men was reduced thoracic expansion at full inflation.

  13. Evaluation of patients undergoing lung volume reduction surgery: Ancillary information available from computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Cleverley, Joanne R.; Desai, Sujal R.; Wells, Athol U.; Koyama, Hiroshi; Eastick, Sian; Schmidt, Maria A.; Charrier, Clare L.; Gatehouse, Peter D.; Goldstraw, Peter; Pepper, John R.; Geddes, Duncan M.; Hansell, David M

    2000-01-01

    AIM: A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS: Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T{sub PERF}), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS: Extensive emphysema was present on HRCT (60% {+-} 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r{sub s}= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P0.04). CONCLUSION: The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS. Cleverley, J.R. (2000)

  14. Bronchoabsorption; a novel bronchoscopic technique to improve biomarker sampling of the airway.

    Science.gov (United States)

    Leaker, B R; Nicholson, G C; Ali, F Y; Daudi, N; O'Connor, B J; Barnes, P J

    2015-09-04

    Current techniques used to obtain lung samples have significant limitations and do not provide reproducible biomarkers of inflammation. We have developed a novel technique that allows multiple sampling methods from the same area (or multiple areas) of the lung under direct bronchoscopic vision. It allows collection of mucosal lining fluid and bronchial brushing from the same site; biopsy samples may also be taken. The novel technique takes the same time as standard procedures and can be conducted safely. Eight healthy smokers aged 40-65 years were included in this study. An absorptive filter paper was applied to the bronchial mucosa under direct vision using standard bronchoscopic techniques. Further samples were obtained from the same site using bronchial brushings. Bronchoalveolar lavage (BAL) was obtained using standard techniques. Chemokine (C-C Motif) Ligand 20 (CCL20), CCL4, CCL5, Chemokine (C-X-C Motif) Ligand 1 (CXCL1), CXCL8, CXCL9, CXCL10, CXCL11, Interleukin 1 beta (IL-1β), IL-6, Vascular endothelial growth factor (VEGF), Matrix metalloproteinase 8 (MMP-8) and MMP-9 were measured in exudate and BAL. mRNA was collected from the bronchial brushings for gene expression analysis. A greater than 10 fold concentration of all the biomarkers was detected in lung exudate in comparison to BAL. High yield of good quality RNA with RNA integrity numbers (RIN) between 7.6 and 9.3 were extracted from the bronchial brushings. The subset of genes measured were reproducible across the samples and corresponded to the inflammatory markers measured in exudate and BAL. The bronchoabsorption technique as described offers the ability to sample lung fluid direct from the site of interest without the dilution effects caused by BAL. Using this method we were able to successfully measure the concentrations of biomarkers present in the lungs as well as collect high yield mRNA samples for gene expression analysis from the same site. This technique demonstrates superior sensitivity

  15. Effects of tongue position and lung volume on voluntary maximal tongue protrusion force in humans.

    Science.gov (United States)

    Saboisky, Julian P; Luu, Billy L; Butler, Jane E; Gandevia, Simon C

    2015-01-15

    Maximal voluntary protrusion force of the human tongue has not been examined in positions beyond the incisors or at different lung volumes. Tongue force was recorded with the tongue tip at eight positions relative to the incisors (12 and 4mm protrusion, neutral and 4, 12, 16, 24 and 32mm retraction) at functional residual capacity (FRC), total lung capacity (TLC) and residual volume (RV) in 15 healthy subjects. Maximal force occurred between 12mm and 32mm retraction (median 16mm). Maximum force at FRC was reproducible at the optimal tongue position across sessions (P=0.68). Across all positions at FRC the average force was highest at 24mm retraction (28.3±5.3N, mean±95% CI) and lowest at 12mm protrusion (49.1±4.6% maximum; Ptongue positions, maximal force was on average 9.3% lower at FRC than TLC and RV (range: 4.5-12.7% maximum, P<0.05). Retracted positions produce higher-force protrusions with a small effect of lung volume.

  16. Intraobserver and interobserver agreement of volume perfusion CT (VPCT) measurements in patients with lung lesions

    Energy Technology Data Exchange (ETDEWEB)

    Sauter, Alexander W., E-mail: alexander.sauter@klinikum.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Merkle, Anne, E-mail: anne_merkle@web.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Schulze, Maximilian, E-mail: maximilian.schulze@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Spira, Daniel, E-mail: daniel.spira@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Hetzel, Juergen, E-mail: juergen.hetzel@med.uni-tuebingen.de [Departments of Oncology, Hematology, Immunology, Rheumatology and Pulmonology, University Hospital of Tuebingen, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany); Claussen, Claus D., E-mail: claus.claussen@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Horger, Marius S., E-mail: marius.horger@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

    2012-10-15

    Objectives: To evaluate intraobserver and interobserver agreement of manually encompassed lung lesions for perfusion measurements using volume-perfusion computed tomography (VPCT). Materials and methods: Institutional review board approval and informed consent were obtained. HIPAA guidelines were followed. A 65-s dynamic study was acquired with scan parameters 80 kV, 60 mA s (80 mA s for patients ≥70 kg), 128 × 0.6 mm collimation. Blood flow (BF), blood volume (BV) and K{sup trans} parameters were determined by syngo volume perfusion CT body with 88 lesions analyzed retrospectively. Results: Within-subject coefficients of variation for intraobserver agreement (range 6.59–12.82%) were superior to those for interobserver agreement (range 21.75–38.30%). Size-dependent analysis revealed lower agreements for lesions <4 cm as compared to larger lesions. Additionally, agreements of the upper, middle and lower lung zones were different. Conclusions: Intraobserver agreement was substantial for VPCT lung cancer perfusion measurements encouraging the use for tumor characterization and therapy response monitoring. Interobserver agreement is limited and unexperienced readers should be trained before using this new method.

  17. Combined use of positron emission tomography and volume doubling time in lung cancer screening with low-dose CT scanning

    DEFF Research Database (Denmark)

    Ashraf, H; Dirksen, A; Jakobsen, Annika Loft

    2011-01-01

    In lung cancer screening the ability to distinguish malignant from benign nodules is a key issue. This study evaluates the ability of positron emission tomography (PET) and volume doubling time (VDT) to discriminate between benign and malignant nodules....

  18. Volume change determination of metastatic lung tumors in CT images using 3-D template matching

    Science.gov (United States)

    Ambrosini, Robert D.; Wang, Peng; O'Dell, Walter G.

    2009-02-01

    The ability of a clinician to properly detect changes in the size of lung nodules over time is a vital element to both the diagnosis of malignant growths and the monitoring of the response of cancerous lesions to therapy. We have developed a novel metastasis sizing algorithm based on 3-D template matching with spherical tumor appearance models that were created to match the expected geometry of the tumors of interest while accounting for potential spatial offsets of nodules in the slice thickness direction. The spherical template that best-fits the overall volume of each lung metastasis was determined through the optimization of the 3-D normalized cross-correlation coefficients (NCCC) calculated between the templates and the nodules. A total of 17 different lung metastases were extracted manually from real patient CT datasets and reconstructed in 3-D using spherical harmonics equations to generate simulated nodules for testing our algorithm. Each metastasis 3-D shape was then subjected to 10%, 25%, 50%, 75% and 90% scaling of its volume to allow for 5 possible volume change combinations relative to the original size per each reconstructed nodule and inserted back into CT datasets with appropriate blurring and noise addition. When plotted against the true volume change, the nodule volume changes calculated by our algorithm for these 85 data points exhibited a high degree of accuracy (slope = 0.9817, R2 = 0.9957). Our results demonstrate that the 3-D template matching method can be an effective, fast, and accurate tool for automated sizing of metastatic tumors.

  19. Reliability and validity of the lung volume measurement made by the BOD POD body composition system.

    Science.gov (United States)

    Davis, James A; Dorado, Silvia; Keays, Kathleen A; Reigel, Kimberly A; Valencia, Kristoffer S; Pham, Patrick H

    2007-01-01

    The BOD POD Body Composition System uses air-displacement plethysmography to measure body volume. To correct the body volume measurement for the subject's lung volume, the BOD POD utilizes pulmonary plethysmography to measure functional residual capacity (FRC) at mid-exhalation as that is the subject's lung volume during the body volume measurement. Normally, FRC is measured at end-exhalation. The BOD POD FRC measurement can be corrected to an end-exhalation volume by subtracting approximately one-half of the measured tidal volume. Our purpose was to determine the reliability and validity of the BOD POD FRC measurement at end-exhalation. Ninety-two healthy adults (half female) underwent duplicate FRC measurements by the BOD POD and one FRC measurement by a traditional gas dilution technique. The latter method was used as the reference method for the validity component of the study. The order of the FRC measurements by the two methods was randomized. The test-retest correlation coefficients for the duplicate BOD POD FRC measurements for the male and female subjects were 0.966 and 0.948, respectively. The mean differences between the BOD POD FRC trial #1 measurement and gas dilution FRC measurement for the male and female subjects were -32 and -23 ml, respectively. Neither difference was statistically significant. The correlation coefficients for these two measurements in the male and female subjects were 0.925 and 0.917, respectively. Based on these results, we conclude that the BOD POD FRC measurement in healthy males and females is both reliable and valid.

  20. Combined use of positron emission tomography and volume doubling time in lung cancer screening with low-dose CT scanning

    DEFF Research Database (Denmark)

    Ashraf, H; Dirksen, A; Jakobsen, Annika Loft

    2011-01-01

    In lung cancer screening the ability to distinguish malignant from benign nodules is a key issue. This study evaluates the ability of positron emission tomography (PET) and volume doubling time (VDT) to discriminate between benign and malignant nodules.......In lung cancer screening the ability to distinguish malignant from benign nodules is a key issue. This study evaluates the ability of positron emission tomography (PET) and volume doubling time (VDT) to discriminate between benign and malignant nodules....

  1. Longitudinal micro-CT provides biomarkers of lung disease that can be used to assess the effect of therapy in preclinical mouse models, and reveal compensatory changes in lung volume.

    Science.gov (United States)

    Vande Velde, Greetje; Poelmans, Jennifer; De Langhe, Ellen; Hillen, Amy; Vanoirbeek, Jeroen; Himmelreich, Uwe; Lories, Rik J

    2016-01-01

    In vivo lung micro-computed tomography (micro-CT) is being increasingly embraced in pulmonary research because it provides longitudinal information on dynamic disease processes in a field in which ex vivo assessment of experimental disease models is still the gold standard. To optimize the quantitative monitoring of progression and therapy of lung diseases, we evaluated longitudinal changes in four different micro-CT-derived biomarkers [aerated lung volume, lung tissue (including lesions) volume, total lung volume and mean lung density], describing normal development, lung infections, inflammation, fibrosis and therapy. Free-breathing mice underwent micro-CT before and repeatedly after induction of lung disease (bleomycin-induced fibrosis, invasive pulmonary aspergillosis, pulmonary cryptococcosis) and therapy (imatinib). The four lung biomarkers were quantified. After the last time point, we performed pulmonary function tests and isolated the lungs for histology. None of the biomarkers remained stable during longitudinal follow-up of adult healthy mouse lungs, implying that biomarkers should be compared with age-matched controls upon intervention. Early inflammation and progressive fibrosis led to a substantial increase in total lung volume, which affects the interpretation of aerated lung volume, tissue volume and mean lung density measures. Upon treatment of fibrotic lung disease, the improvement in aerated lung volume and function was not accompanied by a normalization of the increased total lung volume. Significantly enlarged lungs were also present in models of rapidly and slowly progressing lung infections. The data suggest that total lung volume changes could partly reflect a compensatory mechanism that occurs during disease progression in mice. Our findings underscore the importance of quantifying total lung volume in addition to aerated lung or lesion volumes to accurately document growth and potential compensatory mechanisms in mouse models of lung

  2. [Therapeutic bronchoscopic treatment of postintubation tracheal stenosis: 5 cases].

    Science.gov (United States)

    Karakoca, Yalçin; Karaağaç, Güler; Karakoca, Sevinay; Yildiz, Tülay; Yazanel, Orhan; Sariman, Nesrin; Yildiz, M Erdem; Tekinsoy, Bülent

    2004-01-01

    Benign airway obstruction is known as curable by therapeutic bronchoscopic methods. Compared by surgical therapies it is comfortable and has no risks for the patients. For five patients who applied our clinic after tracheostomy and endotracheal intubation stenosis we used therapeutic bronchoscopic methods; "laser-stenotic silicon stent". In two patients after vaporization of membranous stricture by Neodimum Yttrium Aliminum Pevroskite Laser (Nd-YAP laser) who were seen posttracheostomy and postentubation; stenotic stent was implanted mechanically and/or by means of baloon dilatation. Membranous stricture area was coagulated by Nd-YAP-laser in other three cases and anatomic airway diameter was achieved mechanically and by baloon dilatation. In the follow up period we applied stenotic silicon stent implantation after second laser resection in whom restenosis observed. In conclusion; patients who had stenotic silicon stent implantation and having no problems in the follow up this therapeutic method is found to be curative.

  3. Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis

    Directory of Open Access Journals (Sweden)

    Abdullah Şimşek

    Full Text Available ABSTRACT Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both. Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%. Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%. Smear microscopy of BAL fluid (BALF was performed in 16 patients and was positive for AFB in 10 (62.5%. Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%. Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%; bronchial brushing, in 7 (38.8%; fine-needle aspiration biopsy, in 2 (11.1%; and BAL, in 2 (11.1%. Bronchial anthracofibrosis was observed in 5 (27.7% of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

  4. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    Energy Technology Data Exchange (ETDEWEB)

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F. [Dept. of Radiology, S. Giovanni HS, Rome (Italy); Conforto, F.; Calimici, R.; Salvi, A. [Dept. of Anesthesiology, S. Giovanni HS, Rome (Italy); Matteucci, G. [Dept. of Pneumology, S. Giovanni HS, Rome (Italy)

    2007-06-15

    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 {+-} 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 = hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H{sub 2}O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  5. (3)He MRI in healthy volunteers: preliminary correlation with smoking history and lung volumes.

    Science.gov (United States)

    Guenther, D; Eberle, B; Hast, J; Lill, J; Markstaller, K; Puderbach, M; Schreiber, W G; Hanisch, G; Heussel, C P; Surkau, R; Grossmann, T; Weiler, N; Thelen, M; Kauczor, H U

    2000-06-01

    MRI with hyperpolarized helium-3 ((3)He) provides high-resolution imaging of ventilated airspaces. The first aim of this (3)He-study was to compare observations of localized signal defects in healthy smokers and non-smokers. A second aim was to describe relationships between parameters of lung function, volume of inspired (3)He and signal-to-noise ratio. With Ethics Committee approval and informed consent, 12 healthy volunteers (seven smokers and five non-smokers) were studied. Imaging was performed in a 1.5 T scanner using a two-dimensional FLASH sequence at 30V transmitter amplitude (TR/TE/alpha = 11 ms/4.2 ms/microprocessor-controlled delivery device and imaged during single breath-holds. Images were evaluated visually, and scored using a prospectively defined 'defect-index'. Signal-to-noise ratio of the images were correlated with localization, (3)He volumes and static lung volumes. Due to poor image quality studies of two smokers were not eligible for the evaluation. Smokers differed from non-smokers in total number and size of defects: the 'defect-index' of smokers ranged between 0.8 and 6.0 (median = 1.1), that of non-smokers between 0.1 and 0.8 (median = 0.4). Intraindividually, an anteroposterior gradient of signal-to-noise ratio was apparent. Signal-to-noise ratio correlated with the estimated amount of hyperpolarization administered (r = 0. 77), but not with static lung volumes. We conclude that (3)He MRI is a sensitive measure to detect regional abnormalities in the distribution of ventilation in clinically healthy persons with normal pulmonary function tests.

  6. Value of different bronchoscopic sampling techniques in diagnosis of sarcoidosis: a prospective study of 151 patients.

    Science.gov (United States)

    Goyal, Abhishek; Gupta, Dheeraj; Agarwal, Ritesh; Bal, Amanjit; Nijhawan, Raje; Aggarwal, Ashutosh N

    2014-07-01

    The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis. Consecutive patients with suspected sarcoidosis who underwent fiberoptic bronchoscopy were studied. TBLB, EBB, TBNA, or EBUS-TBNA was performed as indicated in a standardized manner. A diagnosis of sarcoidosis was established based on the finding of non-necrotizing granulomas or on clinical grounds at 6-month follow-up. Individual and cumulative yield of various procedures and their correlation with clinicoradiologic parameters was analyzed. Of the 164 patients studied, 151 were finally diagnosed as sarcoidosis. Granulomas were demonstrated in 127 (84.2%) patients. Diagnostic yield of TBLB, EBB, TBNA, and EBUS-TBNA was 68.7%, 49.6%, 22.43%, and 57.1%, respectively. Cumulative yields of various procedures were: EBB+TBLB 81.4%; TBLB+TBNA 73.7%; TBNA+EBB 62.9%; TBLB+EBB+TBNA 86.9%; and TBLB+EBB+EBUS-TBNA 86.4%. In those with visible mucosal abnormalities, TBLB+EBB conferred the highest diagnostic yield (92.8%). Clinical findings or radiologic stage had no impact on diagnostic yield. TBLB is an important tool in bronchoscopic diagnosis of sarcoidosis. If endobronchial abnormalities are seen during bronchoscopy, TBLB with EBB gives the best results otherwise TBLB combined with conventional TBNA and EBB or EBUS-TBNA are required to maximize the diagnostic yield.

  7. Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    Energy Technology Data Exchange (ETDEWEB)

    Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Pediatric Emergency Room]. E-mail: andreafrag@gmail.com; Toro, Ivan Contrera [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Thoracic Surgery; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Pediatric Pulmonology

    2008-02-15

    Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusions: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention at children younger than three years of age. (author)

  8. GGO nodule volume-preserving nonrigid lung registration using GLCM texture analysis.

    Science.gov (United States)

    Park, Seongjin; Kim, Bohyoung; Lee, Jeongjin; Goo, Jin Mo; Shin, Yeong-Gil

    2011-10-01

    In lung cancer screening, benign and malignant nodules can be classified through nodule growth assessment by the registration and, then, subtraction between follow-up computed tomography scans. During the registration, the volume of nodule regions in the floating image should be preserved, whereas the volume of other regions in the floating image should be aligned to that in the reference image. However, ground glass opacity (GGO) nodules are very elusive to automatically segment due to their inhomogeneous interior. In other words, it is difficult to automatically define the volume-preserving regions of GGO nodules. In this paper, we propose an accurate and fast nonrigid registration method. It applies the volume-preserving constraint to candidate regions of GGO nodules, which are automatically detected by gray-level cooccurrence matrix (GLCM) texture analysis. Considering that GGO nodules can be characterized by their inner inhomogeneity and high intensity, we identify the candidate regions of GGO nodules based on the homogeneity values calculated by the GLCM and the intensity values. Furthermore, we accelerate our nonrigid registration by using Compute Unified Device Architecture (CUDA). In the nonrigid registration process, the computationally expensive procedures of the floating-image transformation and the cost-function calculation are accelerated by using CUDA. The experimental results demonstrated that our method almost perfectly preserves the volume of GGO nodules in the floating image as well as effectively aligns the lung between the reference and floating images. Regarding the computational performance, our CUDA-based method delivers about 20× faster registration than the conventional method. Our method can be successfully applied to a GGO nodule follow-up study and can be extended to the volume-preserving registration and subtraction of specific diseases in other organs (e.g., liver cancer).

  9. Influence of heart failure on resting lung volumes in patients with COPD

    Science.gov (United States)

    de Souza, Aline Soares; Sperandio, Priscila Abreu; Mazzuco, Adriana; Alencar, Maria Clara; Arbex, Flávio Ferlin; de Oliveira, Mayron Faria; O'Donnell, Denis Eunan; Neder, José Alberto

    2016-01-01

    ABSTRACT Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil. PMID:27832235

  10. Influence of heart failure on resting lung volumes in patients with COPD

    Directory of Open Access Journals (Sweden)

    Aline Soares de Souza

    Full Text Available ABSTRACT Objective: To evaluate the influence of chronic heart failure (CHF on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female with COPD+CHF and 32 (28 males/4 females with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC, and TLC-were lower in the former group (p < 0.05. There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05. Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05. Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction. However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.

  11. Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry.

    Science.gov (United States)

    Schultz, Kenia; D'Aquino, Luiz Carlos; Soares, Maria Raquel; Gimenez, Andrea; Pereira, Carlos Alberto de Castro

    2016-01-01

    Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% espirometria não têm CPT reduzida. O objetivo deste estudo foi avaliar o papel da medida dos volumes pulmonares e da resistência das vias aéreas para a classificação correta de pacientes com possível restrição à espirometria. Estudo prospectivo de adultos com CVF e VEF1 reduzidos e relação VEF1/CV(F) na faixa prevista. Distúrbio ventilatório restritivo (DVR) foi definido por CPT espirometria. A obstrução ao fluxo aéreo é comum nesses casos.

  12. Obesity disproportionately impacts lung volumes, airflow and exhaled nitric oxide in children.

    Science.gov (United States)

    Yao, Tsung-Chieh; Tsai, Hui-Ju; Chang, Su-Wei; Chung, Ren-Hua; Hsu, Jing-Ya; Tsai, Ming-Han; Liao, Sui-Ling; Hua, Man-Chin; Lai, Shen-Hao; Chen, Li-Chen; Yeh, Kuo-Wei; Tseng, Yu-Lun; Lin, Wan-Chen; Chang, Su-Ching; Huang, Jing-Long

    2017-01-01

    The current literature focusing on the effect of obesity and overweight on lung function and fraction of exhaled nitric oxide (FeNO) in children, particularly among healthy children of non-European descent, remains controversial. Furthermore, whether the relationship of obesity and overweight with lung function and FeNO in children is modified by atopy is unclear. The objective of this study was to examine the effect of excess weight on lung function parameters and FeNO among Asian children, with a particular focus on exploring the potential effect modification by atopy. We investigated the effect of excess weight on lung function and FeNO in a population sample of 1,717 children aged 5 to 18 years and explored the potential modifying effect of atopy. There were positive associations of body mass index (BMI) z-score with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and forced expiratory flow at 25-75% (FEF25-75) (all Pchildren from the general population, independent of atopic status. Excess weight inversely affects FeNO in atopic but not in non-atopic children.

  13. Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination.The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement.The echogenicity ratio between fetal lung and liver was compared.The...

  14. Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit

    Science.gov (United States)

    Briva, Arturo; Gaiero, Cristina

    2016-01-01

    Objective To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. Methods The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts. Results One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103). Conclusion The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months). PMID:27925055

  15. [Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test].

    Science.gov (United States)

    Bokov, P; Delclaux, C

    2016-02-01

    Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint.

  16. Lung function in North American Indian children: reference standards for spirometry, maximal expiratory flow volume curves, and peak expiratory flow.

    Science.gov (United States)

    Wall, M A; Olson, D; Bonn, B A; Creelman, T; Buist, A S

    1982-02-01

    Reference standards of lung function was determined in 176 healthy North American Indian children (94 girls, 82 boys) 7 to 18 yr of age. Spirometry, maximal expiratory flow volume curves, and peak expiratory flow rate were measured using techniques and equipment recommended by the American Thoracic Society. Standing height was found to be an accurate predictor of lung function, and prediction equations for each lung function variable are presented using standing height as the independent variable. Lung volumes and expiratory flow rates in North American Indian children were similar to those previously reported for white and Mexican-American children but were greater than those in black children. In both boys and girls, lung function increased in a curvilinear fashion. Volume-adjusted maximal expiratory flow rates after expiring 50 or 75% of FVC tended to decrease in both sexes as age and height increased. Our maximal expiratory flow volume curve data suggest that as North American Indian children grow, lung volume increases at a slightly faster rate than airway size does.

  17. Overweight Is an Independent Risk Factor for Reduced Lung Volumes in Myotonic Dystrophy Type 1.

    Directory of Open Access Journals (Sweden)

    Charlotte G W Seijger

    Full Text Available In this large observational study population of 105 myotonic dystrophy type 1 (DM1 patients, we investigate whether bodyweight is a contributor of total lung capacity (TLC independent of the impaired inspiratory muscle strength.Body composition was assessed using the combination of body mass index (BMI and fat-free mass index. Pulmonary function tests and respiratory muscle strength measurements were performed on the same day. Patients were stratified into normal (BMI < 25 kg/m(2 and overweight (BMI ≥ 25 kg/m(2 groups. Multiple linear regression was used to find significant contributors for TLC.Overweight was present in 59% of patients, and body composition was abnormal in almost all patients. In overweight patients, TLC was significantly (p = 2.40×10(-3 decreased, compared with normal-weight patients, while inspiratory muscle strength was similar in both groups. The decrease in TLC in overweight patients was mainly due to a decrease in expiratory reserve volume (ERV further illustrated by a highly significant (p = 1.33×10(-10 correlation between BMI and ERV. Multiple linear regression showed that TLC can be predicted using only BMI and the forced inspiratory volume in 1 second, as these were the only significant contributors.This study shows that, in DM1 patients, overweight further reduces lung volumes, as does impaired inspiratory muscle strength. Additionally, body composition is abnormal in almost all DM1 patients.

  18. Lung function, transfusion, pulmonary capillary blood volume and sickle cell disease.

    Science.gov (United States)

    Lunt, Alan; McGhee, Emily; Robinson, Polly; Rees, David; Height, Susan; Greenough, Anne

    2016-02-01

    Lung function abnormalities occur in children with sickle cell disease (SCD) and may be associated with elevated pulmonary blood volume. To investigate that association, we determined whether blood transfusion in SCD children acutely increased pulmonary capillary blood volume (PCBV) and increased respiratory system resistance (Rrs5). Measurements of Rrs5 and spirometry were made before and after blood transfusion in 18 children, median age 14.2 (6.6-18.5) years. Diffusing capacity for carbon monoxide and nitric oxide were assessed to calculate the PCBV. Post transfusion, the median Rrs5 had increased from 127.4 to 141.3% predicted (pvolume from 39.7 to 64.1 ml/m2 (pvolume in one second (p=0.0056) and vital capacity (p=0.0008) decreased. The increase in Rrs5 correlated with the increase in PCBV (r=0.50, p=0.0493). Increased pulmonary capillary blood volume may at least partially explain the lung function abnormalities in SCD children.

  19. Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration.

    Science.gov (United States)

    Kearns, Mark J; Wang, Yingjin; Boyd, John H

    2015-05-29

    Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft involves anastomosis of donor inferior vena cava (IVC) to recipient IVC, and donor ascending aorta (Ao) to recipient abdominal Ao. The right upper and middle lung lobes are preserved and function as conduits for blood flow from right heart to left heart. There are several advantages to using this technique, and it lends itself to a broad range of applications. Because the graft is transplanted in a configuration that allows for dyamic volume-loading, cardiac function may be directly assessed in vivo. The use of pressure-volume conductance catheters permits characterization of load-dependent and load-independent hemodynamic parameters. The graft may be converted to a loaded configuration by applying a clamp to the recipient's infra-hepatic IVC. We describe modified surgical techniques for both donor and recipient operations, and an ideal myocardial protection strategy. Depending on the experimental aim, this model may be adapted for use in both acute and chronic studies of graft function, immunologic status, and variable ventricular loading conditions. The conducting airways to the transplanted lung are preserved, and allow for acute lung re-ventilation. This facilitates analysis of the effects of the mixed venous and arterial blood providing coronary perfusion to the graft. A limitation of this model is its technical complexity. There is a significant learning curve for new operators, who should ideally be mentored in the technique. A surgical training background is advantageous for those wishing to apply this model. Despite its complexity, we aim to present the model in a clear and easily applicable format. Because of the physiologic similarity of this model to orthotopic transplantation, and its broad range of study applications, the effort invested in learning the technique is likely to be worthwhile.

  20. PRESSURE-VOLUME ANALYSIS OF THE LUNG WITH AN EXPONENTIAL AND LINEAR-EXPONENTIAL MODEL IN ASTHMA AND COPD

    NARCIS (Netherlands)

    BOGAARD, JM; OVERBEEK, SE; VERBRAAK, AFM; VONS, C; FOLGERING, HTM; VANDERMARK, TW; ROOS, CM; STERK, PJ

    1995-01-01

    The prevalence of abnormalities in lung elasticity in patients with asthma or chronic obstructive pulmonary disease (COPD) is still unclear, This might be due to uncertainties concerning the method of analysis of quasistatic deflation long pressure-volume curves. Pressure-volume curves were obtained

  1. Effect of Minimally Invasive Surfactant Therapy on Lung Volume and Ventilation in Preterm Infants.

    Science.gov (United States)

    van der Burg, Pauline S; de Jongh, Frans H; Miedema, Martijn; Frerichs, Inez; van Kaam, Anton H

    2016-03-01

    To assess the changes in (regional) lung volume and gas exchange during minimally invasive surfactant therapy (MIST) in preterm infants with respiratory distress syndrome. In this prospective observational study, infants requiring a fraction of inspired oxygen (FiO2) ≥ 0.30 during nasal continuous positive airway pressure of 6 cmH2O were eligible for MIST. Surfactant (160-240 mg/kg) was administered in supine position in 1-3 minutes via an umbilical catheter placed 2 cm below the vocal cords. Changes in end-expiratory lung volume (EELV), tidal volume, and its distribution were recorded continuously with electrical impedance tomography before and up to 60 minutes after MIST. Changes in transcutaneous oxygen saturation (SpO2) and partial carbon dioxide pressure, FiO2, respiratory rate, and minute ventilation were recorded. A total of 16 preterm infants were included. One patient did not finish study protocol because of severe apnea 10 minutes after MIST. In the remaining infants (gestational age 29.8 ± 2.8 weeks, body weight 1545 ± 481 g) EELV showed a rapid and sustained increase, starting in the dependent lung regions, followed by the nondependent regions approximately 5 minutes later. Oxygenation, expressed as the SpO2/FiO2 ratio, increased from 233 (IQR 206-257) to 418 (IQR 356-446) after 60 minutes (P transcutaneous partial carbon dioxide pressure was comparable with pre-MIST values. Ventilation distribution remained unchanged. MIST results in a rapid and homogeneous increase in EELV, which is associated with an improvement in oxygenation. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Neonatal chest wall suspension splint: a novel and noninvasive method for support of lung volume.

    Science.gov (United States)

    Miller, Thomas L; Palmer, Charles; Shaffer, Thomas H; Wolfson, Marla R

    2005-06-01

    Surfactant and musculoskeletal immaturity results in lower compliance of the lung relative to the chest wall, with clinical manifestations of low lung volume, marked chest wall retractions (CWR), and thoracoabdominal asynchrony. Inspiratory efforts are dissipated on distorting the chest wall inward rather than recruiting lung volumes. The current study tests the hypothesis that a novel neonatal chest wall suspension splint (SP), designed to provide stability to the compliant chest wall, would reduce inspiratory chest wall retractions and improve lung volumes. Nine preterm infants (29 +/- 1 SE weeks of gestation; 1.59 +/- 0.27 SE kg study weight) were studied at 16 +/- 5 SE days of life at baseline (BL) and following application of the front plate (FP) and the full SP (Hug n Snug Neonatal Chest Splint, Respironics, Inc.). Phase angle of thoracoabdominal motion, CWR, functional residual capacity (FRC), and pulmonary function were evaluated during spontaneous breathing. Compared to BL, there was a significant decrease in anterior CWR (2.21 +/- 0.91 SE vs. 0.25 +/- 0.09 SE mm; P < 0.05), an increase in FRC (16.6 +/- 2.8 SE vs. 27.8 +/- 5.5 SE ml/kg; P < 0.05) and tidal volume (4.8 +/- 1.5 SE vs. 7.3 +/- 1.4 SE ml/kg; P < 0.05), minimal effect on pulmonary compliance (1.98 +/- 0.50 SE vs. 1.72 +/- 0.30 SE ml/cmH2O/kg), and a trend for a decrease in phase angle (128.4 +/- 10.9 SE vs. 111.8 +/- 19.3 SE) with the application of the splint. FRC correlated inversely with severity of CWR across all conditions (P < 0.05, r = -0.68). Phase angle was directly correlated to anterior CWR (r = 0.72; P < 0.05) and correlated inversely with FRC (P < 0.005; r = -0.56). We speculate that by improving CW stability, the use of this splint may reduce the energetic requirements of breathing and, potentially, the need for more invasive ventilatory support in the neonate.

  3. High spatiotemporal resolution measurement of regional lung air volumes from 2D phase contrast x-ray images

    Energy Technology Data Exchange (ETDEWEB)

    Leong, Andrew F. T.; Islam, M. Sirajul; Kitchen, Marcus J. [School of Physics, Monash University, Victoria 3800 (Australia); Fouras, Andreas [Division of Biological Engineering, Monash University, Victoria 3800 (Australia); Wallace, Megan J.; Hooper, Stuart B. [Ritchie Centre and Department of Obstetrics and Gynaecology, Monash Institute of Medical Research, Monash University, Victoria 3168 (Australia)

    2013-04-15

    Purpose: Described herein is a new technique for measuring regional lung air volumes from two-dimensional propagation-based phase contrast x-ray (PBI) images at very high spatial and temporal resolution. Phase contrast dramatically increases lung visibility and the outlined volumetric reconstruction technique quantifies dynamic changes in respiratory function. These methods can be used for assessing pulmonary disease and injury and for optimizing mechanical ventilation techniques for preterm infants using animal models. Methods: The volumetric reconstruction combines the algorithms of temporal subtraction and single image phase retrieval (SIPR) to isolate the image of the lungs from the thoracic cage in order to measure regional lung air volumes. The SIPR algorithm was used to recover the change in projected thickness of the lungs on a pixel-by-pixel basis (pixel dimensions {approx}16.2 {mu}m). The technique has been validated using numerical simulation and compared results of measuring regional lung air volumes with and without the use of temporal subtraction for removing the thoracic cage. To test this approach, a series of PBI images of newborn rabbit pups mechanically ventilated at different frequencies was employed. Results: Regional lung air volumes measured from PBI images of newborn rabbit pups showed on average an improvement of at least 20% in 16% of pixels within the lungs in comparison to that measured without the use of temporal subtraction. The majority of pixels that showed an improvement was found to be in regions occupied by bone. Applying the volumetric technique to sequences of PBI images of newborn rabbit pups, it is shown that lung aeration at birth can be highly heterogeneous. Conclusions: This paper presents an image segmentation technique based on temporal subtraction that has successfully been used to isolate the lungs from PBI chest images, allowing the change in lung air volume to be measured over regions as small as the pixel size. Using

  4. Volume-monitored chest CT: a simplified method for obtaining motion-free images near full inspiratory and end expiratory lung volumes

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Kathryn S. [The Ohio State University College of Medicine, Columbus, OH (United States); Long, Frederick R. [Nationwide Children' s Hospital, The Children' s Radiological Institute, Columbus, OH (United States); Flucke, Robert L. [Nationwide Children' s Hospital, Department of Pulmonary Medicine, Columbus, OH (United States); Castile, Robert G. [The Research Institute at Nationwide Children' s Hospital, Center for Perinatal Research, Columbus, OH (United States)

    2010-10-15

    Lung inflation and respiratory motion during chest CT affect diagnostic accuracy and reproducibility. To describe a simple volume-monitored (VM) method for performing reproducible, motion-free full inspiratory and end expiratory chest CT examinations in children. Fifty-two children with cystic fibrosis (mean age 8.8 {+-} 2.2 years) underwent pulmonary function tests and inspiratory and expiratory VM-CT scans (1.25-mm slices, 80-120 kVp, 16-40 mAs) according to an IRB-approved protocol. The VM-CT technique utilizes instruction from a respiratory therapist, a portable spirometer and real-time documentation of lung volume on a computer. CT image quality was evaluated for achievement of targeted lung-volume levels and for respiratory motion. Children achieved 95% of vital capacity during full inspiratory imaging. For end expiratory scans, 92% were at or below the child's end expiratory level. Two expiratory exams were judged to be at suboptimal volumes. Two inspiratory (4%) and three expiratory (6%) exams showed respiratory motion. Overall, 94% of scans were performed at optimal volumes without respiratory motion. The VM-CT technique is a simple, feasible method in children as young as 4 years to achieve reproducible high-quality full inspiratory and end expiratory lung CT images. (orig.)

  5. Emphysema. Imaging for endoscopic lung volume reduction; Lungenemphysem. Bildgebung bei endoskopischer Lungenvolumenreduktion

    Energy Technology Data Exchange (ETDEWEB)

    Storbeck, B. [LungenClinic Grosshansdorf (Germany). Dept. of Radiology; Schroeder, T.H. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); Oldigs, M.; Rabe, K.F. [LungenClinic Grosshansdorf (Germany). Dept. of Pulmonology; Weber, C. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); University Medical Center Hamburg-Eppendorf (Germany). Diagnostic and Interventional Radiology

    2015-07-15

    Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type (''bronchitis'') on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thin-section reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

  6. Automated lung tumor segmentation for whole body PET volume based on novel downhill region growing

    Science.gov (United States)

    Ballangan, Cherry; Wang, Xiuying; Eberl, Stefan; Fulham, Michael; Feng, Dagan

    2010-03-01

    We propose an automated lung tumor segmentation method for whole body PET images based on a novel downhill region growing (DRG) technique, which regards homogeneous tumor hotspots as 3D monotonically decreasing functions. The method has three major steps: thoracic slice extraction with K-means clustering of the slice features; hotspot segmentation with DRG; and decision tree analysis based hotspot classification. To overcome the common problem of leakage into adjacent hotspots in automated lung tumor segmentation, DRG employs the tumors' SUV monotonicity features. DRG also uses gradient magnitude of tumors' SUV to improve tumor boundary definition. We used 14 PET volumes from patients with primary NSCLC for validation. The thoracic region extraction step achieved good and consistent results for all patients despite marked differences in size and shape of the lungs and the presence of large tumors. The DRG technique was able to avoid the problem of leakage into adjacent hotspots and produced a volumetric overlap fraction of 0.61 +/- 0.13 which outperformed four other methods where the overlap fraction varied from 0.40 +/- 0.24 to 0.59 +/- 0.14. Of the 18 tumors in 14 NSCLC studies, 15 lesions were classified correctly, 2 were false negative and 15 were false positive.

  7. Increased Interleukin-8 in Epithelial Lining Fluid of Collapsed Lungs During One-Lung Ventilation for Thoracotomy

    OpenAIRE

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu

    2012-01-01

    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point...

  8. Expression Changes of Early Response Genes in Lung Due to High Volume Ventilation

    Institute of Scientific and Technical Information of China (English)

    WANG Yuelan; YAO Shanglong; XIONG Ping

    2005-01-01

    Summary: The expression changes of early response genes due to ventilation with high volume in adult rats in vivo were observed. Forty SD male rats were randomly divided into control and 30, 60, 90 and 120 min ventilation groups, respectively (n=8 in each group). The animals were ventilated with tidal volume of 42 ml/kg and a PEEP level of 0 cmH2O at a rate of 40 breaths per minute in room air with a ventilator was given to the small animals. The expression of Egr-1, C-jun and IL-1β mRNA and proteins was detected by RT-PCR and immunohistochemical technique, respectively. The pathological changes in lung tissues were examined by HE staining. The results indicated that the expression of Egr-1, C-jun and IL-1β mRNA was detectable at 30th min after overventilation, but there was no significant difference in comparison with that in control group until overventilation for 60 min. However, at 90 and 120 min there was a significent increase as compared with 30 min or control group (P<0.05). The expression of Egr-1, C-jun and IL-1β deteced by immunohistochemical assay also showed a similar tendency of the gradual increase. In the 120 min ventilation group, the expression intensity of Egr-1, C-jun and IL-1β proteins in lung cells was the strongest and the nuclear translocation was increased markedly in comparison with any other groups (P<0.05). HE staining suggested that the degree of lung injury was aggravated gradually with the ventialtion going on and had a similar tendency to the expression of these early response genes and proteins. The current data suggested that overventilation activated and upregulated the expression of early response genes and the expression of these genes may be taken as the early signal to predict the onset and degree of lung injury. These results may demonstrated partially that the expression of early response genes induced by the mechanical stretch is associated with biochamic lung injury.

  9. Effects of swim training on lung volumes and inspiratory muscle conditioning.

    Science.gov (United States)

    Clanton, T L; Dixon, G F; Drake, J; Gadek, J E

    1987-01-01

    Lung volumes and inspiratory muscle (IM) function tests were measured in 16 competitive female swimmers (age 19 +/- 1 yr) before and after 12 wk of swim training. Eight underwent additional IM training; the remaining eight were controls. Vital capacity (VC) increased 0.25 +/- 0.25 liters (P less than 0.01), functional residual capacity (FRC) increased 0.39 +/- 0.29 liters (P less than 0.001), and total lung capacity (TLC) increased 0.35 +/- 0.47 (P less than 0.025) in swimmers, irrespective of IM training. Residual volume (RV) did not change. Maximum inspiratory mouth pressure (PImax) measured at FRC changed -43 +/- 18 cmH2O (P less than 0.005) in swimmers undergoing IM conditioning and -29 +/- 25 (P less than 0.05) in controls. The time that 65% of prestudy PImax could be endured increased in IM trainers (P less than 0.001) and controls (P less than 0.05). All results were compared with similar IM training in normal females (age 21.1 +/- 0.8 yr) in which significant increases in PImax and endurance were observed in IM trainers only with no changes in VC, FRC, or TLC (Clanton et al., Chest 87: 62-66, 1985). We conclude that 1) swim training in mature females increases VC, TLC, and FRC with no effect on RV, and 2) swim training increases IM strength and endurance measured near FRC.

  10. Multidisciplinary collaborative gross tumour volume definition for lung cancer radiotherapy: a prospective study.

    Science.gov (United States)

    Hollingdale, Abigail E; Roques, Tom W; Curtin, John; Martin, W M Craig; Horan, Gail; Barrett, Ann

    2011-12-07

    Variability in gross tumour volume (GTV) definition is a major source of systematic error in conformal radiotherapy. This prospective study assesses the role of multidisciplinary collaboration between oncologists and radiologists in defining lung cancer volumes. Twenty patients with non-small cell lung cancer due to receive three-dimensional conformal radiotherapy formed the study population. GTVs were defined by a radiologist (GTVrad) and an oncologist (GTVonc) using available clinical information and imaging. A collaborative meeting was then held to agree on a final, common GTV (GTVfin) to be used for treatment planning, and differences analysed. The collaboration changed the GTV in 19/20 patients with a total of 50 regions being edited. Changes made were categorized as (a) differentiation of tumour from atelectasis or ground glass shadowing, (b) separation of tumour from vasculature, and (c) defining mediastinal extent of tumour. Oncologists were more confident in the GTVfin than the GTVonc. The radiologist took longer to define the GTV than the oncologist. Real-time collaborative GTV definition by a radiologist and oncologist is practical and feasible. This approach allows specific areas of uncertainty to be categorized and focussed on, reducing systematic error in GTV definition. The physician's approach to risk and decision making for each patient may also play a role.

  11. Small Cell Lung Cancer: The Influence of Dose and Treatment Volume on Outcome.

    Science.gov (United States)

    Lichter; Turrisi

    1995-01-01

    The treatment of small cell lung cancer is clearly enhanced by the addition of radiation therapy. Survival increases modestly while local thoracic failure as first site of progression is reduced from approximately 60% when chemotherapy alone is used to 30% after combined modality therapy. The variables of radiation dose and treatment volume seem to be important in the successful management of this disease. Local chest control appears to increase as doses are escalated from low levels (25 Gy) to moderate levels (45 to 50 Gy(. With about one third of patients experiencing local chest progression, one can speculate that higher radiation doses might be of value. However, at this time there is no proof that increased dose or dose intensity bears out this promise. Indeed, increasing dose intensity of radiotherapy, eg, twice-daily treatment, increases esophagitis, perhaps reduces local failure, but has not improved overall survival. Using larger total doses or altered fraction schemes must still be considered to be under investigation. To increase dose in a safe manner, reduction in the volume covered by radiation portals will likely need to take place. Modern trials suggest that prophylactic treatment of the radiographically or clinically negative contralateral hilum and/or supraclavicular nodal regions may not be necessary for survival or local control. Importantly, reducing treatment volumes may permit increasing doses without exceding normal tissue tolerance. Also, reduced volumes pave the way for further clinical trials that improve radiation dose delivery by better target definition and more conformal therapy.

  12. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  13. PET-based delineation of tumour volumes in lung cancer: comparison with pathological findings

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, Andrea; Mai, Sebastian; Bohnenberger, Hendrik; Kirsch, Carl-Martin; Grgic, Aleksandar [Saarland University Medical Center, Department of Nuclear Medicine, Homburg (Germany); Kim, Yoo Jin; Bohle, Rainer M. [Saarland University Medical Center, Department of Pathology, Homburg (Germany); Kremp, Stephanie; Fleckenstein, Jochen; Ruebe, Christian [Saarland University Medical Center, Department of Radiooncology, Homburg (Germany); Schaefers, Hans-Joachim [Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg (Germany); Kuhnigk, Jan-Martin [MeVis Research Center for Medical Diagnostic Systems and Visualization, Bremen (Germany)

    2013-08-15

    The objective of the study was to validate an adaptive, contrast-oriented thresholding algorithm (COA) for tumour delineation in {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for non-small cell lung cancer (NSCLC) in comparison with pathological findings. The impact of tumour localization, tumour size and uptake heterogeneity on PET delineation results was also investigated. PET tumour delineation by COA was compared with both CT delineation and pathological findings in 15 patients to investigate its validity. Correlations between anatomical volume, metabolic volume and the pathology reference as well as between the corresponding maximal diameters were determined. Differences between PET delineations and pathological results were investigated with respect to tumour localization and uptake heterogeneity. The delineated volumes and maximal diameters measured on PET and CT images significantly correlated with the pathology reference (both r > 0.95, p < 0.0001). Both PET and CT contours resulted in overestimation of the pathological volume (PET 32.5 {+-} 26.5 %, CT 46.6 {+-} 27.4 %). CT volumes were larger than those delineated on PET images (CT 60.6 {+-} 86.3 ml, PET 48.3 {+-} 61.7 ml). Maximal tumour diameters were similar for PET and CT (51.4 {+-} 19.8 mm for CT versus 53.4 {+-} 19.1 mm for PET), slightly overestimating the pathological reference (mean difference CT 4.3 {+-} 3.2 mm, PET 6.2 {+-} 5.1 mm). PET volumes of lung tumours located in the lower lobe were significantly different from those determined from pathology (p = 0.037), whereas no significant differences were observed for tumours located in the upper lobe (p = 0.066). Only minor correlation was found between pathological tumour size and PET heterogeneity (r = -0.24). PET tumour delineation by COA showed a good correlation with pathological findings. Tumour localization had an influence on PET delineation results. The impact of tracer uptake heterogeneity on PET delineation

  14. Influence of heart failure on resting lung volumes in patients with COPD.

    Science.gov (United States)

    Souza, Aline Soares de; Sperandio, Priscila Abreu; Mazzuco, Adriana; Alencar, Maria Clara; Arbex, Flávio Ferlin; Oliveira, Mayron Faria de; O'Donnell, Denis Eunan; Neder, José Alberto

    2016-01-01

    To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 - (end-inspiratory lung volume/TLC)]. This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p espirometria forçada e lenta e pletismografia de corpo inteiro. Os pacientes do grupo DPOC+ICC apresentaram maior VEF1, VEF1/CVF e VEF1/capacidade vital lenta; porém, todos os principais volumes "estáticos" - VR, capacidade residual funcional (CRF) e CPT - foram menores que aqueles do grupo DPOC (p < 0,05). A CRF diminuiu mais do que o VR, determinando assim menor volume de reserva expiratória no grupo DPOC+ICC que no grupo DPOC. Houve redução relativamente proporcional da CRF e da CPT nos dois grupos; logo, a CI também foi similar. Consequentemente, a fração inspiratória no grupo DPOC+ICC foi maior que no grupo DPOC (0,42 ± 0,10 vs. 0,36 ± 0,10; p < 0,05). Embora a razão volume corrente/CI fosse maior no grupo DPOC+ICC, a reserva inspiratória relativa foi notadamente similar entre os grupos (0,35 ± 0,09 vs. 0,44 ± 0,14; p < 0,05). Apesar dos efeitos restritivos da ICC, pacientes com DPOC+ICC apresentam elevações relativas dos limites inspiratórios (maior fração inspiratória). Entretanto, esses pacientes utilizam apenas parte desses limites, com o provável intuito de evitar reduções críticas da reserva inspiratória e maior trabalho elástico.

  15. Effect of high tidal volume ventilation and lipopolysaccharide on mitogen-activated protein kinase in rat lung tissue

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Mechanical ventilation, a crucial therapy to acute respiratory distress syndrome (ARDS), could exacerbate lung injury, and even result in ventilator-induced lung injury (VILI) if misused in some condition1. Over-activating inflammatory cells and expanding inflammatory responses, which are induced by infection, are fundamental reasons for ARDS. Among them, mitogen-activated protein kinase (MAPK) intracellular signal transduction pathways are key processes. This study aimed to investigate the time course of MAPK activation in rat lung tissue after high tidal volume (VT) ventilation and the role of lipopolysaccharide (LPS) in high-sensitivity, and to elucidate the effect of the pathway on VILI.

  16. Lung volume reduction surgery for emphysema: Radiologic findings; Valutazione radiologica nell`intervento di riduzione del volume polmonare per enfisema

    Energy Technology Data Exchange (ETDEWEB)

    Bonfioli, Claudio; Motta, Fabio; Bergonzi, Marco; Urani, Antonio; Montali, Giuseppe [Ospedale Generale `San Giuseppe`, Milan (Italy). Servizio di Radiologia; Varoli, Federico; Vergani, Contardo; Roviaro, Gian Carlo [Ospedale Generale `San Giuseppe`, Milan (Italy). Divisione di Chirurgia

    1997-04-01

    Aim of this work is to present and discuss the radiologic protocol they have developed for the preoperative assessment of patients with severe pulmonary emphysema candidate to lung volume reduction surgery (LVRS). The operation aims at improving respiratory mechanics and reducing small airway obstruction by removing variable amounts of emphysematous parenchyma. January to September, 1996, twelve patients were submitted to LVRS. Before surgery all patients were examined with standard chest radiographs during maximal inspiration and expiration, chest Computed Tomography (CT), High Resolution Computed Tomography (HRCT) and air trapping quantitation on HRCT scans. Diaphragm and chest wall excursions, patterns, site and distribution of emphysema, as well as heterogeneity were investigated, Air trapping was quantitate with a dedicated software. Post-operative studies were carried out 2 months later in 6 patients and included: maximal inspiratory and expiratory chest radiographs and air trapping assessment on 3 standardized HRCT scans. All parameters considered improved in every patient. Radiologic studies proved to be of crucial importance for patient selection and LVRS planning. The diagnostic protocol adopted in their Hospital appears a valuable tool for both pre- and post-operative assessment of the patients candidate to LVRS.

  17. Bronchoscopic intubation is an effective airway strategy in critically ill patients.

    Science.gov (United States)

    Ma, Kevin C; Chung, Augustine; Aronson, Kerri I; Krishnan, Jamuna K; Barjaktarevic, Igor Z; Berlin, David A; Schenck, Edward J

    2017-04-01

    American Society of Anesthesiologists guidelines recommend the use of bronchoscopic intubation as a rescue technique in critically ill patients. We sought to assess the safety and efficacy of bronchoscopic intubation as an initial approach in critically ill patients. We performed a retrospective cohort study of patients who underwent endotracheal intubation in the medical intensive care unit of a tertiary urban referral center over 1 academic year. The primary outcome was first-pass success rate. We identified 219 patients who underwent either bronchoscopic (n=52) or laryngoscopic guided (n=167) intubation as the initial attempt. There was a higher first-pass success rate in the bronchoscopic intubation group than in the laryngoscopic group (96% vs 78%; P=.003). The bronchoscopic intubation group had a higher body mass index (28.4 vs 25.9; P=.027) and higher preintubation fraction of inspired oxygen requirement (0.73±0.27 vs 0.63±0.30; P=.044) than the laryngoscopic group. There were no cases of right mainstem intubation, esophageal intubation, or pneumothorax with bronchoscopic intubation. Rates of postintubation hypotension and hypoxemia were similar in both groups. The association with first-pass success remained with multivariate and propensity matched analysis. Bronchoscopic intubation as an initial strategy in critically ill patients is associated with a higher first-pass success rate than laryngoscopic intubation, and is not associated with an increase in complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Shah, Asad A; D'Amico, Thomas A

    2009-06-01

    This review describes the role of lung volume reduction surgery (LVRS) for the management of refractory dyspnea and other debilitating conditions in patients with chronic obstructive pulmonary disease. Recent studies, including a randomized trial comparing LVRS to medical therapy, are analyzed. LVRS plus optimal medical therapy is superior to medical therapy alone in treating certain subsets of patients with severe emphysema. In patients with predominantly upper lobe emphysema and low-exercise capacity, LVRS not only improves symptoms of dyspnea and exercise intolerance, but also is associated with improved survival. Furthermore, LVRS has recently been shown to be superior to medical therapy in improving other quality of life parameters, such as nutritional status, sleep quality, and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe emphysema. LVRS is an effective strategy in the treatment of properly selected patients with COPD, improving survival and quality of life, including exercise tolerance, dyspnea, oxygen requirement and functional status.

  19. Disodium cromoglycate attenuates hypoxia induced enlargement of end-expiratory lung volume in rats.

    Science.gov (United States)

    Maxová, H; Hezinová, A; Vízek, M

    2011-01-01

    Mechanism responsible for the enlargement of end-expiratory lung volume (EELV) induced by chronic hypoxia remains unclear. The fact that the increase in EELV persists after return to normoxia suggests involvement of morphological changes. Because hypoxia has been also shown to activate lung mast cells, we speculated that they could play in the mechanism increasing EELV similar role as in vessel remodeling in hypoxic pulmonary hypertension (HPH). We, therefore, tested an effect of mast cells degranulation blocker disodium cromoglycate (DSCG) on hypoxia induced EELV enlargement. Ventilatory parameters, EELV and right to left heart weight ratio (RV/LV+S) were measured in male Wistar rats. The experimental group (H+DSCG) was exposed to 3 weeks of normobaric hypoxia and treated with DSCG during the first four days of hypoxia, control group was exposed to hypoxia only (H), two others were kept in normoxia as non-treated (N) and treated (N+DSCG) groups. DSCG treatment significantly attenuated the EELV enlargement (H+DSCG = 6.1+/-0.8; H = 9.2+/-0.9; ml +/-SE) together with the increase in minute ventilation (H + DSCG = 190+/-8; H = 273 +/- 10; ml/min +/- SE) and RV/LV + S (H + DSCG = 0.39 +/- 0.03; H = 0.50 +/- 0.06).

  20. Surgical treatment of patients with lung cancer and limited lung function: Preoperative assessment, operative mortality and morbidity

    Directory of Open Access Journals (Sweden)

    Subotić Dragan

    2007-01-01

    Full Text Available Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1 between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairment, operative mortality was 3.1%. In the analyzed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analyzed and control groups occurred in 14.7% and 6.1% of patients respectively (p>0.05. Conclusion. Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and

  1. Modeling of photon migration in the human lung using a finite volume solver

    Science.gov (United States)

    Sikorski, Zbigniew; Furmanczyk, Michal; Przekwas, Andrzej J.

    2006-02-01

    The application of the frequency domain and steady-state diffusive optical spectroscopy (DOS) and steady-state near infrared spectroscopy (NIRS) to diagnosis of the human lung injury challenges many elements of these techniques. These include the DOS/NIRS instrument performance and accurate models of light transport in heterogeneous thorax tissue. The thorax tissue not only consists of different media (e.g. chest wall with ribs, lungs) but its optical properties also vary with time due to respiration and changes in thorax geometry with contusion (e.g. pneumothorax or hemothorax). This paper presents a finite volume solver developed to model photon migration in the diffusion approximation in heterogeneous complex 3D tissues. The code applies boundary conditions that account for Fresnel reflections. We propose an effective diffusion coefficient for the void volumes (pneumothorax) based on the assumption of the Lambertian diffusion of photons entering the pleural cavity and accounting for the local pleural cavity thickness. The code has been validated using the MCML Monte Carlo code as a benchmark. The code environment enables a semi-automatic preparation of 3D computational geometry from medical images and its rapid automatic meshing. We present the application of the code to analysis/optimization of the hybrid DOS/NIRS/ultrasound technique in which ultrasound provides data on the localization of thorax tissue boundaries. The code effectiveness (3D complex case computation takes 1 second) enables its use to quantitatively relate detected light signal to absorption and reduced scattering coefficients that are indicators of the pulmonary physiologic state (hemoglobin concentration and oxygenation).

  2. Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

    Directory of Open Access Journals (Sweden)

    Yannick Molgat-Seon

    2017-03-01

    Full Text Available The aim of the present study was to determine whether lung volume recruitment (LVR acutely increases respiratory system compliance (Crs in individuals with severe respiratory muscle weakness (RMW. Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12 and healthy controls (n=12 underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p0.05. LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05. During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05. LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

  3. [The role of rigid bronchoscope in the diagnosis and treatment of plastic bronchitis].

    Science.gov (United States)

    Wang, Yafang; Song, Yingluan; Wang, Xiaodong; Zhang, Lili; Liu, Xiaofeng; Wen, Xin; Zhao, Haitao

    2015-11-01

    To explore the role of rigid bronchoscope in the diagnosis and treatment of plastic bronchitis. Various clinical parameters, the key points of operation and postoperative recovery were analyzed in 8 patients with plastic bronchitis treated in Department and ICU using retrospective analysis. All cases demonstrated bronchial lumen stenosis, mucous membrance coarse, congestion, edema in the affected side. 2 cases had follicular hyperplasia, 1 case had a few ooze after taking out the plastic type. All cases had endogenous foreign bodies, taking the shape of the bronchial tree or a funicular. Block shape and sites were as follows: right main bronchus 2 cases, superior lobe of right lung 1 case, right middle bronchial 1 case, left main bronchus 2 cases, 1 case with left lower lobe, right main bronchus and left lower lobe bronchus 1 case. The breath sounds of the affected side become more enhanced after operation, with the alliviation of dyspnea. All cases recovered after ICU treatment. The pathologic examination were all type I plastic bronchitis. Removement of the endogenous foreign body via rigid bronchoscopy is the effective method in the treatment of plastic bronchitis. Plastic bronchitis is a rapid-developing critical, urgent disease.In order to reduce the mortality, early diagnosis and timely surgery are necessary.

  4. Automated localization and segmentation of lung tumor from PET-CT thorax volumes based on image feature analysis.

    Science.gov (United States)

    Cui, Hui; Wang, Xiuying; Feng, Dagan

    2012-01-01

    Positron emission tomography - computed tomography (PET-CT) plays an essential role in early tumor detection, diagnosis, staging and treatment. Automated and more accurate lung tumor detection and delineation from PET-CT is challenging. In this paper, on the basis of quantitative analysis of contrast feature of PET volume in SUV (standardized uptake value), our method firstly automatically localized the lung tumor. Then based on analysing the surrounding CT features of the initial tumor definition, our decision strategy determines the tumor segmentation from CT or from PET. The algorithm has been validated on 20 PET-CT studies involving non-small cell lung cancer (NSCLC). Experimental results demonstrated that our method was able to segment the tumor when adjacent to mediastinum or chest wall, and the algorithm outperformed the other five lung segmentation methods in terms of overlapping measure.

  5. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

    OpenAIRE

    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at th...

  6. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  7. A Gaussian mixture model for definition of lung tumor volumes in positron emission tomography.

    Science.gov (United States)

    Aristophanous, Michalis; Penney, Bill C; Martel, Mary K; Pelizzari, Charles A

    2007-11-01

    The increased interest in 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in radiation treatment planning in the past five years necessitated the independent and accurate segmentation of gross tumor volume (GTV) from FDG-PET scans. In some studies the radiation oncologist contours the GTV based on a computed tomography scan, while incorporating pertinent data from the PET images. Alternatively, a simple threshold, typically 40% of the maximum intensity, has been employed to differentiate tumor from normal tissue, while other researchers have developed algorithms to aid the PET based GTV definition. None of these methods, however, results in reliable PET tumor segmentation that can be used for more sophisticated treatment plans. For this reason, we developed a Gaussian mixture model (GMM) based segmentation technique on selected PET tumor regions from non-small cell lung cancer patients. The purpose of this study was to investigate the feasibility of using a GMM-based tumor volume definition in a robust, reliable and reproducible way. A GMM relies on the idea that any distribution, in our case a distribution of image intensities, can be expressed as a mixture of Gaussian densities representing different classes. According to our implementation, each class belongs to one of three regions in the image; the background (B), the uncertain (U) and the target (T), and from these regions we can obtain the tumor volume. User interaction in the implementation is required, but is limited to the initialization of the model parameters and the selection of an "analysis region" to which the modeling is restricted. The segmentation was developed on three and tested on another four clinical cases to ensure robustness against differences observed in the clinic. It also compared favorably with thresholding at 40% of the maximum intensity and a threshold determination function based on tumor to background image intensities proposed in a recent paper. The parts of the

  8. Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volume mechanical ventilation.

    Science.gov (United States)

    Casetti, Alfredo V; Bartlett, Robert H; Hirschl, Ronald B

    2002-10-01

    Ventilator-induced lung injury may be caused by overdistension of alveoli during high-pressure ventilation. In this study, we examined the effects of increasing inspiratory time on ventilator-induced lung injury. Sprague-Dawley rats were divided into four different groups with ten animals per group. Each group was then ventilated for 30 mins with one of four ventilator strategies. All groups were ventilated with an Fio2 of 1.0 and a positive end-expiratory pressure of 0 cm H2O. Group LoP was the negative control group and was ventilated with low pressures (peak inspiratory pressure = 12 cm H2O, rate = 30, and inspiratory time = 0.5 secs). Groups iT = 0.5, iT = 1.0, and iT = 1.5 were the experimental groups and were ventilated with high pressures (peak inspiratory pressure = 45 cm H2O, rate = 10, and inspiratory times = 0.5 secs, iT = 1.0 sec, and iT = 1.5 secs, respectively). Outcome measures included lung compliance, Pao /Fio ratio, wet/dry lung weight, and dry lung/body weight. Final static lung compliance (p =.0002) and Pao2/Fio2 (p =.001) decreased as inspiratory time increased. Wet/dry lung weights (p <.0001) and dry lung/body weights (p <.0001) increased as inspiratory time increased. Light microscopy revealed evidence of intra-alveolar edema and hemorrhage in the iT = 1.0 and iT = 1.5 animals but not the LoP and iT = 0.5 animals. Increasing inspiratory time during high-pressure/high-volume mechanical ventilation is associated with an increase in variables of lung injury.

  9. Effect of fiberoptic bronchoscope compared with direct laryngoscope on hemodynamic responses to orotracheal intubation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Guo-hua; XUE Fu-shan; LI Ping; SUN Hai-yan; LIU Kun-peng; XU Ya-chao; LIU Yi; SUN Hai-tao

    2007-01-01

    @@ Fiberoptic bronchoscope (FOB) is an important instrument for respiratory, disorder examination and difficult airway management.1 The fiberoptic intubation can avoid the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic responses during orotracheal intubation.

  10. Bronchoscopic electrocauterization versus argon plasma coagulation as a palliative management for patients with bronchogenic carcinoma

    Directory of Open Access Journals (Sweden)

    Amgad A. Farhat

    2015-01-01

    It was concluded that, therapeutic bronchoscopic intervention either by electrocautery or argon plasma coagulation is a safe and effective method for palliative management of patients with central malignant airway obstruction.

  11. An evaluation of the feasibility of assessment of volume perfusion for the whole lung by 128-slice spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Haitao [Imaging Center of Taian Central Hospital, Taian, Shandong (China); Gao, Fei; Li, Ning; Liu, Cheng [Shandong Univ., Shandong Medical Imaging Research Inst., CT Room, Shandong (China)], e-mail: liucheng491025@sina.com

    2013-10-15

    Background: Lung perfusion based on dynamic scanning cannot provide a quantitative assessment of the whole lung because of the limited coverage of the current computed tomography (CT) detector designs. Purpose: To evaluate the feasibility of dynamic volume perfusion CT (VPCT) of the whole lung using a 128-slice CT for the quantitative assessment and visualization of pulmonary perfusion. Material and Methods: Imaging was performed in a control group of 17 subjects who had no signs of disturbance of pulmonary function or diffuse lung disease, and 15 patients (five patients with acute pulmonary embolism and 10 with emphysema) who constituted the abnormal lung group. Dynamic VPCT was performed in all subjects, and pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time (MTT) were calculated from dynamic contrast images with a coverage of 20.7 cm. Regional and volumetric PBF, PBV, and MTT were statistically evaluated and comparisons were made between the normal and abnormal lung groups. Results: Regional PBF (94.2{+-}36.5, 161.8 {+-}29.6, 185.7 {+-}38.1 and 125.5 {+-}46.1, 161.9 {+-}31.4, 169.3 {+-}51.7), PBV (6.7 {+-}2.8, 10.9 {+-}3.0, 12.9 {+-}4.5 and 9.9 {+-}4.6, 10.3 {+-}2.9, 11.9 {+-}4.5), and MTT (5.8 {+-}2.4, 4.5 {+-}1.3, 4.7 {+-}2.1 and 5.6 {+-}2.3, 4.3 {+-}1.5, 4.9 {+-}1.5) demonstrated significant differences in the gravitational and isogravitational directions in the normal lung group (P < 0.05). The PBF (154.2 {+-}30.6 vs. 94.9 {+-}15.9) and PBV (11.1 {+-}4.0 vs. 6.6 {+-}1.7) by dynamic VPCT showed significant differences between normal and abnormal lungs (P < 0.05), notwithstanding the four large lungs that had coverage > 20.7 cm. Conclusion: Dynamic VPCT of the whole lung is feasible for the quantitative assessment of pulmonary perfusion by 128-slice CT, and may in future permit the evaluation of both morphological and functional features of the whole lung in a single examination.

  12. SU-E-J-78: Internal Target Volume Delineation for Lung Tumors in Patients Treated with Robotic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Descovich, M; Pinnaduwage, D; Kirby, N; Gottschalk, A; Yom, S; Pouliot, J; Braunstein, S [UC San Francisco, San Francisco, CA (United States)

    2014-06-01

    Purpose: To compare different approaches for Internal Target Volume (ITV) delineation for patients treated with fiducial-free robotic radiosurgery for primary and metastatic lung tumors. Methods: Ten patients undergoing Lung-Optimized Treatment (LOT) for robotic radiosurgery were imaged with inhale and exhale breath-hold CT scans and 8-phase 4DCT scan. We evaluated the differences in internal target volume (ITV) delineated using three approaches: 1) maximum intensity projection (MIP) images reconstructed from 4DCT scan (ITV-MIP); 2) linear interpolation of Gross Tumor Volumes (GTV) segmented on inhale and exhale breath-hold scans (ITV-BH); 3) linear interpolation of GTV segmented on inhale and exhale phases of 4DCT scan (ITV-2Phase). All contours were independently generated by the same radiation oncologist using lung window settings. Patients had ITV-MIP volumes ranging from 1.5 to 146.9 cc (mean 36.8 cc) located in various parts of the lung. Volume overlap and matching index (MI) were calculated and compared. The MI between two volumes was defined as the ratio of their intersection to their union. MI of 1 indicates the volumes are identical; MI of 0 indicates that there is no overlap. Results: The three approaches generated very different results. The average (SD) MI for ITV-MIP and ITV-BH was 0.52 (0.24); for ITV-MIP and ITV-2Phase it was 0.69 (0.13); and for ITV-BH and ITV-2Phase was 0.57 (0.21), (ANOVA, p=0.16). Relative to the ITV-MIP, the percentage of volume overlap was 72% (26%) and 90% (7%) for ITV-BH and ITV-2Phase, respectively (t-test, p=0.05). Conclusion: Differences between ITV-BH and ITV-MIP are due to inconsistent lung filling at breath-hold and nonlinear tumor motion. Therefore, methods to check breath-hold scanning against regular patient breathing patterns should be developed. Whenever possible, ITV-BH generated by the LOT workflow should be verified by 4DCT data.

  13. Lung protection during non-invasive synchronized assist versus volume control in rabbits

    National Research Council Canada - National Science Library

    Mirabella, Lucia; Grasselli, Giacomo; Haitsma, Jack J; Zhang, Haibo; Slutsky, Arthur S; Sinderby, Christer; Beck, Jennifer

    2014-01-01

    .... For this, we used non-invasive Neurally Adjusted Ventilatory Assist (NIV-NAVA), with the hypothesis that liberation of upper airways and the ventilator's integration with lung protective reflexes would be equally lung protective...

  14. Mid-term effects of lung volume reduction surgery on pulmonary function in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    LIU Jin-ming; WU Wen; LI Xia; Jonson Bjorn; YANG Wen-lan; JIANG Ge-ning; DING Jia-an; ZHENG Wei; LIU Wen-zeng; WANG Ying-min; GAO Bei-lan; JIANG Ping

    2007-01-01

    Background Now lung volume reduction surgery (LVRS) has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease (COPD). We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD.Methods Ten male patients with severe COPD aged 38-70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance (6MWD) test was performed.Results As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery,but returned to the preoperative levels after 3 years.Conclusions LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS.Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.

  15. Impact of ambroxol hydrochloride combined with bronchoscope lavage on level of lung function of patients with severe pulmonary infections%重症肺部感染患者盐酸氨溴索气管镜灌洗对肺功能水平的影响研究

    Institute of Scientific and Technical Information of China (English)

    尚茜; 商伟娜; 翟琳; 刘淑娟; 李娟

    2015-01-01

    目的:研究盐酸氨溴索联合气管镜灌洗对重症肺部感染患者血氧分压(PaO2)、氧合指数(PaO2/FiO2)及血液氧饱和度(SaO2)等水平的影响,为临床治疗提供参考依据。方法选取2012年10月-2013年10月收治的重症肺部感染行气管切开的患者92例,随机将其分为观察组及对照组,每组46例;对照组患者静脉滴入盐酸氨溴索治疗,观察组在对照组基础上联合纤维支气管镜对支气管肺泡进行灌洗以及吸痰治疗,对比两组患者PaO2、PaO2/FiO2及SaO2等水平变化,数据采用 SPSS 13.0软件进行统计分析。结果观察组患者治疗后 PaO2、PaO2/FiO2及SaO2等水平显著高于治疗前,及对照组治疗后,差异均有统计学意义(P<0.05);观察组患者有效率为93.48%,高于对照组的69.57%,差异有统计学意义( P<0.05)。结论盐酸氨溴索联合气管镜可有效改善重症肺部感染患者PaO2、PaO2/FiO2及SaO2等水平,并缩短各项治疗时间,提高临床治疗效果。%OBJECTIVE To study the impact of ambroxol hydrochloride combined with bronchoscope lavage on the levels of partial pressure of arterial oxygen (PaO2 ) ,the ratio of the partial pressure of oxygen to the inspired frac‐tion of oxygen (PaO2/FiO2 ) ,and arterial oxygen saturation (SaO2 ) of the patients with severe pulmonary infec‐tions so as to provide guidance for the clinical treatment .METHODS A total of 92 patients with severe pulmonary infections who underwent the tracheotomy from Oct 2012 to Oct 2013 were enrolled in the study and randomly di‐vided into the observation group and the control group ,with 46 cases in each .The control group was treated with ambroxol hydrochloride ,while the observation group was treated with ambroxol hydrochloride combined with bronchofibroscope for bronchoalveolar lavage and was treated with sputum suction ,and the statistical analysis was performed with the

  16. [Effect of lung volume reduction surgery (LVRS) on nutritional status in patients with COPD].

    Science.gov (United States)

    Kobayashi, Atsushi; Yoshikawa, Masanori; Kushibe, Keiji; Takenaka, Hideaki; Hukuoka, Atsuhiko; Tamaki, Shinji; Kimura, Hiroshi

    2003-12-01

    The beneficial effects of lung volume reduction surgery (LVRS) on patients with severe chronic obstructive pulmonary disease (COPD) on pulmonary function and exercise performance has been established. However, the impact on nutritional status and prognosis has not been demonstrated. In the present study, we investigated the changes in nutritional status in COPD patients undergoing bilateral thoracoscopic LVRS and also analyzed the relationship between nutritional status and postoperative complications and prognosis. After LVRS, body weight, fat-free mass (FFM) and caloric intake were significantly increased. Increase in FFM correlated significantly with improvement in exercise performance. In underweight patients before LVRS, the incidence of post-operative complications was significantly higher than in normal-weight patients, and a patient who was moderately-to-severely underweight (% ideal body weight nutritional status after LVRS contributes to improvement in exercise performance, and that preoperative nutritional status has a significant impact on postoperative morbidity and mortality. From our data, we concluded that preoperative nutritional assessment is an important part of the preoperative evaluation of LVRS, and that LVRS provides nutritional benefits for underweight patients with severe COPD.

  17. Xenobiotic metabolizing enzyme gene polymorphisms predict response to lung volume reduction surgery

    Directory of Open Access Journals (Sweden)

    DeMeo Dawn L

    2007-08-01

    Full Text Available Abstract Background In the National Emphysema Treatment Trial (NETT, marked variability in response to lung volume reduction surgery (LVRS was observed. We sought to identify genetic differences which may explain some of this variability. Methods In 203 subjects from the NETT Genetics Ancillary Study, four outcome measures were used to define response to LVRS at six months: modified BODE index, post-bronchodilator FEV1, maximum work achieved on a cardiopulmonary exercise test, and University of California, San Diego shortness of breath questionnaire. Sixty-four single nucleotide polymorphisms (SNPs were genotyped in five genes previously shown to be associated with chronic obstructive pulmonary disease susceptibility, exercise capacity, or emphysema distribution. Results A SNP upstream from glutathione S-transferase pi (GSTP1; p = 0.003 and a coding SNP in microsomal epoxide hydrolase (EPHX1; p = 0.02 were each associated with change in BODE score. These effects appeared to be strongest in patients in the non-upper lobe predominant, low exercise subgroup. A promoter SNP in EPHX1 was associated with change in BODE score (p = 0.008, with the strongest effects in patients with upper lobe predominant emphysema and low exercise capacity. One additional SNP in GSTP1 and three additional SNPs in EPHX1 were associated (p Conclusion Genetic variants in GSTP1 and EPHX1, two genes encoding xenobiotic metabolizing enzymes, were predictive of response to LVRS. These polymorphisms may identify patients most likely to benefit from LVRS.

  18. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up.

    Science.gov (United States)

    Fruchter, Oren; El Raouf, Bayya Abed; Abdel-Rahman, Nader; Saute, Milton; Bruckheimer, Elchanan; Kramer, Mordechai R

    2014-01-01

    The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (<30 days) mortality was 13% (4 patients). At follow-up, 14 patients (45%) are still alive. Out of 12 patients with late mortality, in 5 patients (41%) the death was directly related to cancer relapse, and no patient died due to BPF recurrence. Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients. © 2013 S. Karger AG, Basel.

  19. Do the number and volume of surgical lung biopsies influence the diagnostic yield in interstitial lung disease? A propensity score analysis.

    Science.gov (United States)

    Fibla, Juan J; Brunelli, Alessandro; Allen, Mark S; Wigle, Dennis; Shen, Robert; Nichols, Francis; Deschamps, Claude; Cassivi, Stephen D

    2015-02-01

    Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influence the diagnosis of diffuse interstitial lung disease (ILD). Retrospective study of SLB for suspected ILD in patients from the Mayo Clinic from January 2002 to January 2010. Data were collected in the institution and analyzed. 311 patients were studied. Mean number of biopsies was 2.05 (SD 0.6); 1 biopsy in 50 (16%), 2 in 198 (63.7%), 3 in 59 (19%) and 4 in 4 (1.3%). Histopathologic diagnosis was: definitive (specific): 232 (74.6%), descriptive (non-specific): 76 (24.4%), no diagnosis: 3 (1%). After excluding patients without diagnosis (n=3), there were 50 patients with only 1 biopsy, 196 with 2 and 62 with 3 or 4; the definitive diagnostic yield was similar in all 3 groups (37/50; 74%, 150/196; 77%, and 45/62; 73%) (Chi-square, p value 0.8). The propensity score analysis between patients with 1 SLB and patients with more than 1 SLB also showed no difference in diagnostic yield. Regarding the volume of biopsies, mean total volume was 34.4 cm(3) (SD 46): 41.2 cm(3) (3 cases) in patients with no diagnosis; 33.6 cm(3) (232 cases, SD 47) in patients with specific diagnosis; and 36.6 cm(3) (76 cases, SD 44) in patients with descriptive diagnosis. Biopsy volume had no influence on histopathology yield (ANOVA, p value .8). The number and volume of the biopsy specimens in SLB did not seem to influence diagnosis. Based on our results, we believe a single sample from a representative area may be sufficient for diagnosis. Randomized prospective trials should be performed to optimize SLB for ILD. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  20. Lymphopenia Association With Gross Tumor Volume and Lung V5 and Its Effects on Non-Small Cell Lung Cancer Patient Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Chad [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing, E-mail: zliao@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel; Levy, Lawrence; Zhuang, Yan; Gebremichael, Rediet A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hong, David S. [Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Komaki, Ritsuko; Welsh, James W. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-08-01

    Purpose: Radiation therapy (RT) can both suppress and stimulate the immune system. We sought to investigate the mechanisms underlying radiation-induced lymphopenia and its associations with patient outcomes in non-small cell lung cancer (NSCLC). Methods and Materials: Subjects consisted of 711 patients who had received definitive RT for NSCLC. A lymphocyte nadir was calculated as the minimum lymphocyte value measured during definitive RT. Associations between gross tumor volumes (GTVs) and lung dose-volume histogram (DVH) parameters with lymphocyte nadirs were assessed with Spearman correlation coefficients. Relationships between lymphocyte nadirs with overall survival (OS) and event free survival (EFS) were evaluated with Kaplan-Meier analysis and compared with log-rank test results. Multivariate regressions were conducted with linear and Cox regression analyses. All variables were analyzed as continuous if possible. Results: Larger GTVs were correlated with lower lymphocyte nadirs regardless of concurrent chemotherapy receipt (with concurrent: r = −0.26, P<.0001; without: r = −0.48, P<.0001). Analyses of lung DVH parameters revealed significant correlations at lower doses (lung V5-V10: P<.0001) that incrementally decreased and became nonsignificant at higher doses (lung V60-V70: P>.05). Of note, no significant associations were detected between GTV and lung DVH parameters with total leukocyte, neutrophil, or monocyte nadirs during RT or with lymphocyte count prior to RT. Multivariate analysis revealed larger GTV (P<.0001), receipt of concurrent chemotherapy (P<.0001), twice-daily radiation fractionation (P=.02), and stage III disease (P=.05) to be associated with lower lymphocyte nadirs. On univariate analysis, patients with higher lymphocyte nadirs exhibited significantly improved OS (hazard ratio [HR] = 0.51 per 10{sup 3} lymphocytes/μL, P=.01) and EFS (HR = 0.46 per 10{sup 3} lymphocytes/μL, P<.0001). These differences held on multivariate analyses

  1. Relationship between dose-volume parameters and pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for lung cancer

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    Takahashi, Shigeo; Shibata, Toru [Kagawa University Hospital, Department of Radiation Oncology, Kagawa (Japan); Go, Tetsuhiko; Kasai, Yoshitaka; Yokomise, Hiroyasu [Kagawa University, Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa (Japan)

    2016-09-15

    This study evaluated the relationship between dose-volume histogram (DVH) parameters and pulmonary complications after neoadjuvant chemoradiotherapy (NACRT) followed by surgery for lung cancer. We also examined a new DVH parameter, because the unresected lung should be more spared than the later resected lung. Data from 43 non-small cell lung cancer patients were retrospectively analyzed. The DVH parameters of the lung were calculated from the total bilateral lung volume minus (1) the gross tumor volume (DVHg) or (2) the later resected lung volume (DVHr). Radiation pneumonitis (RP) and fistula, including bronchopleural and pulmonary fistula, were graded as the pulmonary complications. Factors affecting the incidences of grade 2 or higher RP (≥G2 RP) and fistula were analyzed. Sixteen patients (37 %) experienced ≥G2 RP and a V20 value of the total lung minus the later resected lung (V20r) ≥ 12 % was a significant factor affecting the incidence of ≥G2 RP (p = 0.032). Six patients (14 %) developed a fistula and a V35 value of the total lung minus the gross tumor (V35g) ≥ 19 % and a V40g ≥ 16 % were significant factors affecting the incidence of fistula (p = 0.002 and 0.009, respectively). These DVH parameters may be related to the incidences of ≥G2 RP and fistula. (orig.) [German] In dieser Studie wurde die Beziehung zwischen Dosis-Volumen-Histogramm-(DVH-)Parametern und pulmonalen Komplikationen nach neoadjuvanter Radiochemotherapie (NARCT) und nachfolgender Operation beim Lungenkarzinom untersucht. Zudem wurde ein neuer DVH-Parameter untersucht, da das nichtresezierte Lungengewebe mehr geschont werden sollte als reseziertes Gewebe. Daten von 43 Patienten mit nicht-kleinzelligem Bronchialkarzinom wurden retrospektiv analysiert. Die DVH-Parameter der Lunge wurden aus dem gesamten beidseitigen Lungenvolumen minus (1) das makroskopische Tumorvolumen (DVHg) oder (2) das resezierte Lungenvolumen (DVHr) ermittelt. Strahlenpneumonitis (RP) und Fisteln

  2. Assessment of bronchodilator response through changes in lung volumes in chronic airflow obstruction

    Directory of Open Access Journals (Sweden)

    J.B. Figueroa-Casas

    2003-10-01

    Full Text Available Although FEV1 improvement is routinely used to define bronchodilator (BD response, it correlates poorly with clinical effects. Changes in lung volumes (LV have shown better correlation with exercise tolerance and might be more sensitive to detect BD effects. We assessed the additional contribution of measuring LV before and after BD to detect acute improvement in lung function not demonstrated by FEV1, and the influence of the response criteria selected on this contribution. We analyzed 98 spirometries and plethismographies performed pre and post BD in patients with airflow obstruction (FEV1/FVC 10% of baseline (D>5 anD>15% were also analyzed. FEV1 identified as responders 32% of patients. Greater proportions were uncovered by slow vital capacity (51%, p5 anD>15%. Mean change and proportions of responders for each LV varied significantly (pSi bien el aumento del VEF1 es habitualmente utilizado para definir respuesta a broncodilatadores (BD, su correlación con efectos clínicos es pobre. Los cambios en volúmenes pulmonares (VP han demostrado mejor correlación con tolerancia al ejercicio y podrían ser más sensibles para detectar efectos de los BD. Nosotros evaluamos la contribución adicional de medir VP antes y después de BD para detectar mejoría funcional aguda no demostrada por cambios del VEF1, y la influencia del criterio de respuesta seleccionado en esta contribución. Se analizaron 98 espirometrías y pletismografías realizadas pre y post BD en pacientes con obstrucción al flujo aéreo (VEF1/CVF 10% del basal (D>5 y 15% fueron también analizados. El VEF1 identificó como respondedores a 32% de los pacientes. Proporciones mayores fueron identificadas por capacidad vital lenta (51%, p5 y 15%. El cambio promedio y las proporciones de respondedores para cada VP variaron significativamente (p<0.05 según que el cambio fuese expresado como porcentaje del basal o del valor predicho. Una proporción considerable de pacientes con obstrucci

  3. Cerebral air embolism following transbronchial lung biopsy during flexible bronchoscopy

    Directory of Open Access Journals (Sweden)

    Matthew Evison

    2014-01-01

    Transbronchial lung biopsy may cause disruption of vessels walls within the lung parenchyma. Increased airway pressure, caused by the patient exhaling against a bronchoscope wedged within a segmental bronchi, may subsequently force air bubbles through the vessel wall defects. This may explain the occurrence of air emboli. This is a rare report of air embolism complicating transbronchial lung biopsy and all bronchoscopists should aware of this potentially fatal complication.

  4. Cumulative Intracranial Tumor Volume (CITV) Enhances the Prognostic Value of the Lung-Specific Graded Prognostic Assessment (GPA) Model.

    Science.gov (United States)

    Marcus, Logan P; Marshall, Deborah; Hirshman, Brian R; McCutcheon, Brandon A; Gonda, David D; Koiso, Takao; Hattangadi-Gluth, Jona A; Carter, Bob S; Yamamoto, Masaaki; Chen, Clark C

    2016-08-01

    Management of patients afflicted with brain metastasis requires tailoring of therapeutic strategies based on survival expectations. Therefore, the development of prognostic indices is of critical importance in this patient population. To determine whether the cumulative intracranial tumor volume (CITV) of brain metastasis augments the prognostic value of the lung-specific Graded Prognostic Assessment (GPA) index. Patient data were derived from 365 lung cancer patients with brain metastasis who were consecutively treated with stereotactic radiosurgery at the University of California, San Diego/San Diego Gamma Knife Center. CITV was analyzed to determine the volume cutoff that maximized sensitivity and specificity for 1-year survival. Multivariate Cox proportional hazard modeling was performed, and overall survival was estimated by the Kaplan-Meier method risk stratifying with or without this optimal CITV. The prognostic value of these models (lung-specific GPA ± CITV) was quantitatively compared with the use of net reclassification improvement (>0) and integrated discrimination improvement. For the University of California, San Diego/San Diego Gamma Knife Center cohort, the CITV cutoff that had the greatest survival discrimination at 1 year was 4 cm. The addition of CITV to the lung-specific GPA indexes significantly improved the prognostic value of lung-specific GPA, with net reclassification improvement >0 of 0.430 (95% confidence interval, 0.228-0.629) and integrated discrimination improvement of 0.029 (95% confidence interval, 0.004-0.073). These findings were validated in an independent cohort of 1638 lung cancer patients with brain metastasis who were treated with stereotactic radiosurgery at the Katsuta Hospital Mito Gamma House in Japan. In independent cohorts, the addition of CITV to the lung-specific GPA index significantly improved the prognostic value of this index. AUC, area under the receiver-operating characteristic curveBM, brain metastasis

  5. Diagnostic value of diffuse and peripheral lung lesions by transbronchial lung biopsy

    Institute of Scientific and Technical Information of China (English)

    石志红; 魏霞; 卫小红; 朱柏

    2008-01-01

    Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33...

  6. “High Frequency/Small Tidal Volume Differential Lung Ventilation”: A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery

    Directory of Open Access Journals (Sweden)

    Bassam M. Shoman

    2015-01-01

    Full Text Available With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use of effective one lung ventilation, the patient hemodynamics and respiratory parameters could be deranged and could not be tolerating the procedure that could compromise the end result of surgery. We are presenting our experience in managing one patient who suffered persistent hypoxia and hemodynamic instability with one lung ventilation for robotically assisted thymectomy procedure and how it was managed till the completion of the surgery successfully.

  7. Optimal dose and volume for postoperative radiotherapy in brain oligometastases from lung cancer: a retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Seung Yeun; Kim, Hye Ryun; Cho, Byoung Chul; Lee, Chang Geol; Suh, Chang Ok [Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chang, Jong Hee [Dept. of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2017-06-15

    To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ± boost (WBRT ± boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). The WBRT ± boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ± boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ≥42.3 Gy compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

  8. Lung Volume Reduction in Chronic Obstructive Pulmonary Disease (COPD AND#8211; An Updated Review of Surgical and Endoscopic Procedures

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-08-01

    Full Text Available The conventional medical management of emphysema using bronchodilators and anti-inflammatory agents has a limited benefit in patients having advanced hyperinflation of lungs due to destruction of elastic tissue. The natural course of Chronic Obstructive Pulmonary Disease (COPD has been shown to be altered by only smoking cessation and oxygen therapy so far. The lung volume reduction surgery is viewed as another modality to change the natural history of emphysema in recent years. For patients with more generalized emphysema, resection of lung parenchyma improves elastic recoil and chest wall mechanics. An extensive literature search has demonstrated that carefully selected patients of emphysema (i.e. upper lobe predominant disease, low exercise capacity and Forced Expiratory Volume in First Second (FEV1 and DLco and #8804; 20% of predicted receive benefits in terms of symptomatic improvement and physiologic response following Lung Volume Reduction Surgery (LVRS. The resurgent interest in LVRS and National Emphysema Treatment Trial findings for emphysema have stimulated a range of innovative methods, to improve the outcome and reduce complications associated with current LVRS techniques. These novel approaches include surgical resection with compression/banding devices, endobronchial blockers, sealants, obstructing devices and valves and endobronchial bronchial bypass approaches. Experimental data and preliminary results are becoming available for some of these approaches. Most of the published studies so far have been uncontrolled and unblinded. Overall, extensive research in the near future will help to determine the potential clinical applicability of these new approaches to the treatment of emphysema symptoms. [Arch Clin Exp Surg 2012; 1(4.000: 249-257

  9. Variability in the cardiac EIT image as a function of electrode position, lung volume and body position.

    Science.gov (United States)

    Patterson, R P; Zhang, J; Mason, L I; Jerosch-Herold, M

    2001-02-01

    A study was conducted using the Sheffield electrical impedance tomography (EIT) portable system DAS-01 P to determine the change in the cardiac image with electrode position, lung volume and body position. Sixteen electrodes were positioned in three transverse planes around the thorax at the level of the second intercostal space, at the level of the xiphisternal joint, and midway between upper and lower locations. Data were collected at each electrode level with the breath held at end expiration and after inspiring 0.5, 1 and 1.5 l of air with the subject in both the supine and sitting position. These data were analysed using a Matlab developed program that calculates the average resistivity change in the cardiac region from automatically determined borders. Results show significant individual variability with electrode position and air volume. The middle electrode most consistently shows an increase in impedance in the region of the heart during systole. In some subjects the change in the ventricular-volume-like curve showed a greater than 50% change as a function of lung volume. The pattern of variability with electrode position was not consistent among subjects. In one subject MRI images were obtained to compare actual structures with those seen in the EIT image. The results suggest that using these electrode locations reliable and consistent data, which could be used in clinical applications, cannot be obtained.

  10. Volumetric analysis of lung nodules in computed tomography (CT): comparison of two different segmentation algorithm softwares and two different reconstruction filters on automated volume calculation.

    Science.gov (United States)

    Christe, Andreas; Brönnimann, Alain; Vock, Peter

    2014-02-01

    A precise detection of volume change allows for better estimating the biological behavior of the lung nodules. Postprocessing tools with automated detection, segmentation, and volumetric analysis of lung nodules may expedite radiological processes and give additional confidence to the radiologists. To compare two different postprocessing software algorithms (LMS Lung, Median Technologies; LungCARE®, Siemens) in CT volumetric measurement and to analyze the effect of soft (B30) and hard reconstruction filter (B70) on automated volume measurement. Between January 2010 and April 2010, 45 patients with a total of 113 pulmonary nodules were included. The CT exam was performed on a 64-row multidetector CT scanner (Somatom Sensation, Siemens, Erlangen, Germany) with the following parameters: collimation, 24x1.2 mm; pitch, 1.15; voltage, 120 kVp; reference tube current-time, 100 mAs. Automated volumetric measurement of each lung nodule was performed with the two different postprocessing algorithms based on two reconstruction filters (B30 and B70). The average relative volume measurement difference (VME%) and the limits of agreement between two methods were used for comparison. At soft reconstruction filters the LMS system produced mean nodule volumes that were 34.1% (P filters (B30) was significantly larger than with hard filters (B70); 11.2% for LMS and 1.6% for LungCARE®, respectively (both with P filters, 13.6% for soft and 3.8% for hard filters, respectively (P  0.05). There is a substantial inter-software (LMS/LungCARE®) as well as intra-software variability (B30/B70) in lung nodule volume measurement; therefore, it is mandatory to use the same equipment with the same reconstruction filter for the follow-up of lung nodule volume.

  11. Impact of PET - CT motion correction in minimising the gross tumour volume in non-small cell lung cancer

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    Michael Masoomi

    2013-10-01

    Full Text Available AbstractObjective: To investigate the impact of respiratory motion on localization, and quantification lung lesions for the Gross Tumour Volume utilizing an in-house developed Auto3Dreg programme and dynamic NURBS-based cardiac-torso digitised phantom (NCAT. Methods: Respiratory motion may result in more than 30% underestimation of the SUV values of lung, liver and kidney tumour lesions. The motion correction technique adopted in this study was an image-based motion correction approach using, an in-house developed voxel-intensity-based and a multi-resolution multi-optimisation (MRMO algorithm. All the generated frames were co-registered to a reference frame using a time efficient scheme. The NCAT phantom was used to generate CT attenuation maps and activity distribution volumes for the lung regions. Quantitative assessment including Region of Interest (ROI, image fidelity and image correlation techniques, as well as semi-quantitative line profile analysis and qualitatively overlaying non-motion and motion corrected image frames were performed. Results: the largest transformation was observed in the Z-direction. The greatest translation was for the frame 3, end inspiration, and the smallest for the frame 5 which was closet frame to the reference frame at 67% expiration. Visual assessment of the lesion sizes, 20-60mm at 3 different locations, apex, mid and base of lung showed noticeable improvement for all the foci and their locations. The maximum improvements for the image fidelity were from 0.395 to 0.930 within the lesion volume of interest. The greatest improvement in activity concentration underestimation, post motion correction, was 7% below the true activity for the 20 mm lesion. The discrepancies in activity underestimation were reduced with increasing the lesion sizes. Overlay activity distribution on the attenuation map showed improved localization of the PET metabolic information to the anatomical CT images. Conclusion: The respiratory

  12. Factors affecting the lung perfused blood volume in patients with intrapulmonary clots after anti-coagulation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Munemasa, E-mail: radokada@yamaguchi-u.ac.jp [Department of Radiology, Yamaguchi University Graduate School of Medicine 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Masuda, Yu [4th Grade of 6-year Medicine Doctor Program, Department of Medicine, Yamaguchi University Faculty of Medicine and Health Sciences 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Nakashima, Yoshiteru [Department of Radiology, Yamaguchi Grand Medical Center, Oosaki 77, Hofu, Yamaguchi 747-8511 (Japan); Nomura, Takafumi; Nakao, Sei [Department of Radiology, Yamaguchi University Graduate School of Medicine 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Suga, Kazuyoshi [Department of Radiology, St Hills Hospital, Imamurakita 3-7-18, Ube, Yamaguchi 755-0155 (Japan); Kido, Shoji [Computer-aided Diagnosis and Biomedical Imaging Research Biomedical Engineering, Applied Medical Engineering Science Graduate School of Medicine, Yamaguchi University, Tokiwadai 2-16-1, Ube, Yamaguchi 755-8611 (Japan); Matsunaga, Naofumi [Department of Radiology, Yamaguchi University Graduate School of Medicine 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan)

    2015-08-15

    Highlights: • Dual-energy CT can provide morphological and functional lung images in the same examination. • The subsequent dual-energy CT demonstrates the increased whole lung perfused blood volume (V{sub 120}) despite the residual intrapulmonary clots after treatment in one examination. • The increased whole lung perfusion (V{sub 120}) and a decreased low perfusion volume (V{sub 5}) result in the improvement in the low perfusion rate (%V{sub 5}) in the patients with acute pulmonary embolism after treatment. - Abstract: Objectives: Factors affecting the improvement in the lung perfused blood volume (LPBV) were evaluated based on the presence of intrapulmonary clots (IPCs) after anti-coagulation therapy using 64-slice dual-energy CT. Materials and methods: 96 patients exhibiting venous thromboembolism underwent initial and repeated LPBV examinations between December 2008 and July 2014. Fifteen patients were excluded due to pulmonary comorbidities, and a total of 81 patients were included in this study. Acute pulmonary embolism (PE) was diagnosed in 46 of the patients (56.7%). LPBV images were three-dimensionally reconstructed with two threshold ranges: 1–120 HU (V{sub 120}) and 1–5 HU (V{sub 5}), and the relative value of V{sub 5} per V{sub 120} expressed as %V{sub 5}. These values were subsequently compared with indicators of the severity of PE, such as the D-dimer level, heart rate and CT measurements. This study was approved by the local ethics committee. Results: In patients with IPCs, the D-dimer, V{sub 5} and %V{sub 5}values were significantly larger (p ≤ 0.01) in the initial LPBV, although these differences disappeared in subsequent LPBV after treatment. The right ventricular (RV) diameter, RV/left ventricular (RV/LV) diameter ratio and %V{sub 5} values were also significantly reduced, whereas the V{sub 5} value did not significantly decrease (p = 0.07), but V{sub 120} value significantly increased (p < 0.001) after treatment. However, in

  13. Inclusion of functional information from perfusion SPECT improves predictive value of dose-volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study

    DEFF Research Database (Denmark)

    Farr, Katherina P; Kallehauge, Jesper F; Møller, Ditte S;

    2015-01-01

    BACKGROUND AND PURPOSE: To compare functional and standard dose-volume parameters as predictors of postradiation pulmonary toxicity in lung cancer patients undergoing curative chemo-radiotherapy (RT) studied prospectively. MATERIAL AND METHODS: A total of 58 patients treated with Intensity...... pneumonitis (RP) grade 2-5. RESULTS: Functional mean lung dose (MLD) and lung volumes receiving 5, 10, 20 and 30Gy (V5-V30, respectively) revealed high correlation with corresponding standard parameters (r>0.8). Standard MLD, V20 and V30 were significantly higher in patients with RP (p=0.01). All functional...... Modulated RT (60-66Gy) were analysed. Standard dose-volume parameters were extracted from treatment planning computed tomography (CT) scans. Corresponding functional dose-volume parameters were calculated from perfusion single-photon emission computed tomography (SPECT). Primary end-point was radiation...

  14. [Intubation Using a Double-lumen Tube with a Combination of Fiberoptic Bronchoscope and the Glidescope in a Patient with Difficult Airway].

    Science.gov (United States)

    Tateura, Nao; Sato, Hiromi; Arai, Takero; Asai, Takashi; Okuda, Yasuhisa

    2015-08-01

    A 54-year-old man with lung cancer was scheduled for thoracoscopic upper lobe resection under general anesthesia. About half a year previously, he had undergone surgery for oropharyngeal cancer and tongue cancer. As a result of the surgery, elasticity of the neck skin bending of the neck were restricted (Mallampati classification IV). A narrow-bored tracheostomy tube (speech cannula) was inserted. In the operating room, the tip of a 5.0 mm ID standard tube was inserted from the tracheostomy tube, and connected to a breathing circuit. Anesthesia was induced with inhalation of sevoflurane, followed by intravenous propofol, fentanyl, and rocuronium. Four anesthesiologists were required to intubate the trachea. One person held the tracheal tube placed in the tracheotomy tube. The second person performed jaw thrusting. The third person inserted the Glidescope to shift the transplanted tongue to the side. It was then possible for the forth anesthesiologist to manage to see the glottis using a fiberoptic bronchoscope, and a double-lumen tube (DLT) could be inserted to the trachea orally. Inserting a DLT over the fiberoptic bronchoscope is a blind method, but we felt that combined with a variety of tools such as video laryngoscope, the success rate in intubation will increase.

  15. “High Frequency/Small Tidal Volume Differential Lung Ventilation”: A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery

    OpenAIRE

    Shoman, Bassam M.; Hany O. Ragab; Ammar Mustafa; Rashid Mazhar

    2015-01-01

    With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use o...

  16. Pulmonary vascular volume ratio measured by cardiac computed tomography in children and young adults with congenital heart disease: comparison with lung perfusion scintigraphy.

    Science.gov (United States)

    Goo, Hyun Woo; Park, Sang Hyub

    2017-06-23

    Lung perfusion scintigraphy is regarded as the gold standard for evaluating differential lung perfusion ratio in congenital heart disease. To compare cardiac CT with lung perfusion scintigraphy for estimated pulmonary vascular volume ratio in patients with congenital heart disease. We included 52 children and young adults (median age 4 years, range 2 months to 28 years; 31 males) with congenital heart disease who underwent cardiac CT and lung perfusion scintigraphy without an interim surgical or transcatheter intervention and within 1 year. We calculated the right and left pulmonary vascular volumes using threshold-based CT volumetry. Then we compared right pulmonary vascular volume percentages at cardiac CT with right lung perfusion percentages at lung perfusion scintigraphy by using paired t-test and Bland-Altman analysis. The right pulmonary vascular volume percentages at cardiac CT (66.3 ± 14.0%) were significantly smaller than the right lung perfusion percentages at lung perfusion scintigraphy (69.1 ± 15.0%; P=0.001). Bland-Altman analysis showed a mean difference of -2.8 ± 5.8% and 95% limits of agreement (-14.1%, 8.5%) between these two variables. Cardiac CT, in a single examination, can offer pulmonary vascular volume ratio in addition to pulmonary artery anatomy essential for evaluating peripheral pulmonary artery stenosis in patients with congenital heart disease. However there is a wide range of agreement between cardiac CT and lung perfusion scintigraphy.

  17. Automatic segmentation of airway tree based on local intensity filter and machine learning technique in 3D chest CT volume.

    Science.gov (United States)

    Meng, Qier; Kitasaka, Takayuki; Nimura, Yukitaka; Oda, Masahiro; Ueno, Junji; Mori, Kensaku

    2017-02-01

    Airway segmentation plays an important role in analyzing chest computed tomography (CT) volumes for computerized lung cancer detection, emphysema diagnosis and pre- and intra-operative bronchoscope navigation. However, obtaining a complete 3D airway tree structure from a CT volume is quite a challenging task. Several researchers have proposed automated airway segmentation algorithms basically based on region growing and machine learning techniques. However, these methods fail to detect the peripheral bronchial branches, which results in a large amount of leakage. This paper presents a novel approach for more accurate extraction of the complex airway tree. This proposed segmentation method is composed of three steps. First, Hessian analysis is utilized to enhance the tube-like structure in CT volumes; then, an adaptive multiscale cavity enhancement filter is employed to detect the cavity-like structure with different radii. In the second step, support vector machine learning will be utilized to remove the false positive (FP) regions from the result obtained in the previous step. Finally, the graph-cut algorithm is used to refine the candidate voxels to form an integrated airway tree. A test dataset including 50 standard-dose chest CT volumes was used for evaluating our proposed method. The average extraction rate was about 79.1 % with the significantly decreased FP rate. A new method of airway segmentation based on local intensity structure and machine learning technique was developed. The method was shown to be feasible for airway segmentation in a computer-aided diagnosis system for a lung and bronchoscope guidance system.

  18. [Role of functional imaging in the definition of target volumes for lung cancer radiotherapy].

    Science.gov (United States)

    Thureau, S; Hapdey, S; Vera, P

    2016-10-01

    Functional imaging with positron emission tomography (PET) is interesting to optimize lung radiotherapy planning, and probably to deliver a heterogeneous dose or adapt the radiation dose during treatment. Only fluorodeoxyglucose (FDG) PET-computed tomography (CT) is validated for staging lung cancer and planning radiotherapy. The optimal segmentation methods remain to be defined as well as the interest of "dose painting" from pre-treatment PET (metabolism: FDG) or hypoxia (fluoromisonidazole: FMISO) and the interest of replanning based on pertherapeutic PET.

  19. Interfractional changes in tumour volume and position during entire radiotherapy courses for lung cancer with respiratory gating and image guidance

    Energy Technology Data Exchange (ETDEWEB)

    Juhler-Noettrup, Trine; Korreman, Stine S.; Pedersen, Anders N.; Persson, Gitte F.; Aarup, Lasse R.; Nystroem, Haakan; Olsen, Mikael; Tarnavski, Nikolai; Specht, Lena (Dept. of Radiation Oncology, The Finsen Centre, Copenhagen (Denmark))

    2008-08-15

    Introduction. With the purpose of implementing gated radiotherapy for lung cancer patients, this study investigated the interfraction variations in tumour size and internal displacement over entire treatment courses. To explore the potential of image guided radiotherapy (IGRT) the variations were measured using a set-up strategy based on imaging of bony landmarks and compared to a strategy using in room lasers, skin tattoos and cupper landmarks. Materials and methods. During their six week treatment course of 60Gy in 2Gy fractions, ten patients underwent 3 respiratory gated CT scans. The tumours were contoured on each CT scan to evaluate the variations in volumes and position. The lung tumours and the mediastinal tumours were contoured separately. The positional variations were measured as 3D mobility vectors and correlated to matching of the scans using the two different strategies. Results. The tumour size was significantly reduced from the first to the last CT scan. For the lung tumours the reduction was 19%, p=0.03, and for the mediastinal tumours the reduction was 34%, p=0.0007. The mean 3D mobility vector and the SD for the lung tumours was 0.51cm (+-0.21) for matching using bony landmarks and 0.85cm (+-0.54) for matching using skin tattoos. For the mediastinal tumours the corresponding vectors and SD's were 0.55cm (+-0.19) and 0.72cm (+-0.43). The differences between the vectors were significant for the lung tumours p=0.004. The interfractional overlap of lung tumours was 80-87% when matched using bony landmarks and 70-76% when matched using skin tattoos. The overlap of the mediastinal tumours were 60-65% and 41-47%, respectively. Conclusions. Despite the use of gating the tumours varied considerably, regarding both position and volume. The variations in position were dependent on the set-up strategy. Set-up using IGRT was superior to set-up using skin tattoos.

  20. Limits of dose escalation in lung cancer: a dose-volume histogram analysis comparing coplanar and non-coplanar techniques

    Energy Technology Data Exchange (ETDEWEB)

    Derycke, S.; Van Duyse, B.; Schelfhout, J.; De Neve, W.

    1995-12-01

    To evaluate the feasibility of dose escalation in radiotherapy of inoperable lung cancer, a dose-volume histogram analysis was performed comparing standard coplanar (2D) with non-coplanar (3D) beam arrangements on a non-selected group of 20 patients planned by Sherouse`s GRATISTM 3D-planning system. Serial CT-scanning was performed and 2 Target Volumes (Tvs) were defined. Gross Tumor Volume (GTV) defined a high-dose Target Volume (TV-1). GTV plus location of node stations with > 10% probability of invasion (Minet et al.) defined an intermediate-dose Target Volume (TV-2). However, nodal regions which are incompatible with cure were excluded from TV-2. These are ATS-regions 1, 8, 9 and 14 all left and right as well as heterolateral regions. For 3D-planning, Beam`s Eye View selected (by an experienced planner) beam arrangements were optimised using Superdot, a method of target dose-gradient annihilation developed by Sherouse. A second 3D-planning was performed using 4 beam incidences with maximal angular separation. The linac`s isocenter for the optimal arrangement was located at the geometrical center of gravity of a tetraheder, the tetraheder`s comers being the consecutive positions of the virtual source. This ideal beam arrangement was approximated as close as possible, taking into account technical limitations (patient-couch-gantry collisions). Criteria for tolerance were met if no points inside the spinal cord exceeded 50 Gy and if at least 50% of the lung volume received less than 20Gy. If dose regions below 50 Gy were judged acceptable at TV-2, 2D- as well as 3D-plans allow safe escalation to 80 Gy at TV-1. When TV-2 needed to be encompassed by isodose surfaces exceeding 50Gy, 3D-plans were necessary to limit dose at the spinal cord below tolerance. For large TVs dose is limited by lung tolerance for 3D-plans. An analysis (including NTCP-TCP as cost functions) of rival 3D-plans is being performed.

  1. Nursing and Cooperation of Bronchoscopic Cryotherapy to Endobronchial Tuberculosis%电子支气管镜下冷冻治疗66例支气管结核的配合与护理

    Institute of Scientific and Technical Information of China (English)

    唐静; 李盛芝; 张广宇; 王玲玲; 王睿岚

    2011-01-01

    目的:探讨冷冻治疗支气管结核治疗中的治疗配合及护理.方法:66例患者均经抗结核药物全身治疗和电子气管镜下冷冻治疗,气管镜冷冻治疗过程中,加强术中监护和心理护理,保证病人安全,观察临床疗效.结果:63例病人临床症状完全或部分改善,胸部影像学见肺不张全部或部分复张,但形成的气道狭窄较前减轻(1/2~2/3)以上,3例患者经冷冻治疗后无效.结论:冷冻治疗对支气管结核的治疗效果肯定,应用有上升趋势,关注气管镜下冷冻治疗病人实施整体优质护理.%Objective:To study nursing and cooperation of bronchoscopic cryotherapy to endobronchial tuberculosis.Methods:Bronchoscopic cryotherapy and anti-tuberculosis chemotherapy were applied to 66 endobronchial tuberculosis patients.To intensify intraoperative monitoring and psychological nursing,ensure safety of patients,observe the effect.Results:clinical symptoms were improved totally or partly in 63 patients,lung recruitment were observed and airway stenosis alleviated(1/2~2/3).No effect was observed in 3 patients.Conclusion: Bronchoscopic cryotherapy to endobronchial tuberculosis has a positive effect,increasing trend of application.Holistic nursing should be concerned in bronchoscopic cryotherapy to endobronchial tuberculosis.

  2. Clinical Roles of Lung Volumes Detected by Body Plethysmography and Helium Dilution in Asthmatic Patients: A Correlation and Diagnosis Analysis

    Science.gov (United States)

    Luo, Jian; Liu, Dan; Chen, Guo; Liang, Binmiao; Liu, Chuntao

    2017-01-01

    Roles of lung volumes in asthma remain controversial. We aimed to evaluate the efficacy of lung volumes in differentiating asthma severity levels. Consecutive outpatients with chronic persistent asthma were enrolled, and body plethysmography (BP) and helium dilution (HD) were performed simultaneously to extract RV%pred, TLC%pred, and RV/TLC. Significant negative correlations were found between FEV1%pred and RV%pred (r = −0.557, P TLC%pred (r = −0.387, P TLC (r = −0.485, P TLC). In mild and moderate asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.723 (95%CI 0.571–0.874, P = 0.005) and 0.739 (95%CI 0.607–0.872, P = 0.002) with sensitivity and specificity being 79.41% and 88.24%, and 65.22% and 56.52% at cut-off of 145.40% and 14.23%, respectively. In moderate and severe asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.782 (95%CI 0.671–0.893, P < 0.001) and 0.788 (95%CI 0.681–0.894, P < 0.002) with sensitivity and specificity being 77.78% and 97.22%, and 73.53% and 52.94% at cut-off of 179.85% and 20.22%, respectively. In conclusion, lung volumes are reliable complement of FEV1 in identifying asthma severity levels. PMID:28098214

  3. Lung membrane conductance and capillary volume derived from the NO and CO transfer in high-altitude newcomers.

    Science.gov (United States)

    Martinot, Jean-Benoît; Mulè, Massimiliano; de Bisschop, Claire; Overbeek, Maria J; Le-Dong, Nhat-Nam; Naeije, Robert; Guénard, Hervé

    2013-07-15

    Acute exposure to high altitude may induce changes in carbon monoxide (CO) membrane conductance (DmCO) and capillary lung volume (Vc). Measurements were performed in 25 lowlanders at Brussels (D0), at 4,300 m after a 2- or 3-day exposure (D2,3) without preceding climbing, and 5 days later (D7,8), before and after an exercise test, under a trial with two arterial pulmonary vasodilators or a placebo. The nitric oxide (NO)/CO transfer method was used, assuming both infinite and finite values to the NO blood conductance (θNO). Doppler echocardiography provided hemodynamic data. Compared with sea level, lung diffusing capacity for CO increased by 24% at D2,3 and is returned to control at D7,8. The acute increase in lung diffusing capacity for CO resulted from increases in DmCO and Vc with finite and infinite θNO assumptions. The alveolar volume increased by 16% at D2,3 and normalized at D7,8. The mean increase in systolic arterial pulmonary pressure at rest at D2,3 was minimal. In conclusion, the acute increase in Vc may be related to the increase in alveolar volume and to the increase in capillary pressure. Compared with the infinite θNO value, the use of a finite θNO value led to about a twofold increase in DmCO value and to a persistent increase in DmCO at D7,8 compared with D0. After exercise, DmCO decreased slightly less in subjects treated by the vasodilators, suggesting a beneficial effect on interstitial edema.

  4. Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc

    Directory of Open Access Journals (Sweden)

    Fogliata Antonella

    2010-10-01

    Full Text Available Abstract Background To report acute toxicity, initial outcome results and planning therapeutic parameters in radiation treatment of advanced lung cancer (stage III with volumetric modulated arcs using RapidArc (RA. Methods Twenty-four consecutive patients were treated with RA. All showed locally advanced non-small cell lung cancer with stage IIIA-IIIB and with large volumes (GTV:299 ± 175 cm3, PTV:818 ± 206 cm3. Dose prescription was 66Gy in 33 fractions to mean PTV. Delivery was performed with two partial arcs with a 6 MV photon beam. Results From a dosimetric point of view, RA allowed us to respect most planning objectives on target volumes and organs at risk. In particular: for GTV D1% = 105.6 ± 1.7%, D99% = 96.7 ± 1.8%, D5%-D95% = 6.3 ± 1.4%; contra-lateral lung mean dose resulted in 13.7 ± 3.9Gy, for spinal cord D1% = 39.5 ± 4.0Gy, for heart V45Gy = 9.0 ± 7.0Gy, for esophagus D1% = 67.4 ± 2.2Gy. Delivery time was 133 ± 7s. At three months partial remission > 50% was observed in 56% of patients. Acute toxicities at 3 months showed 91% with grade 1 and 9% with grade 2 esophageal toxicity; 18% presented grade 1 and 9% with grade 2 pneumonia; no grade 3 acute toxicity was observed. The short follow-up does not allow assessment of local control and progression free survival. Conclusions RA proved to be a safe and advantageous treatment modality for NSCLC with large volumes. Long term observation of patients is needed to assess outcome and late toxicity.

  5. Evaluation of parameters of the HDV (V20 and dose average) in radiotherapy of lung cancer with lung volumes design adapted compounds (ITV); Evaluacion de parametros del HDV (V20 Y Dmed) en radioterapia adaptada de cancer de pulmon con diseno de volumenes pulmonares compuestos (ITV)

    Energy Technology Data Exchange (ETDEWEB)

    Monroy Anton, J. L.; Solar Tortosa, M.; Lopez Munoz, M.; Navarro Bergada, A.; Estornell Gualde, M. A.; Melchor Iniguez, M.

    2013-07-01

    Our objective was to evaluate the V20 parameters and dose average compared to a single lung volume designed with a CT study in normal breathing of the patient and the corresponding to a lung volume composed, designed from three studies of CT in different phases of the respiratory cycle. Check if there are important differences in these cases that determine the necessity of creating a composite lung volume to evaluate dose volume histogram. (Author)

  6. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs

    Directory of Open Access Journals (Sweden)

    Andreas eFahlman

    2014-11-01

    Full Text Available We examined structural properties of the marine mammal respiratory system, and tested Scholander’s hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus. We found that the chest wall compliance (CCW of all five species was greater than lung compliance (airways and alveoli, CL as predicted by Scholander, which suggests that the chest provides little protection against alveolar collapse or lung squeeze. We also found that specific respiratory compliance was significantly greater in wild animals than in animals raised under human care. While differences in ages between the two groups may affect this incidental finding, it is also possible that lung conditioning in free-living animals may increase pulmonary compliance and reduce the risk of lung squeeze during diving. Overall, our data indicate that compliance of excised pinniped lungs provide a good estimate of total respiratory compliance.

  7. Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

    Directory of Open Access Journals (Sweden)

    Marcela Cangussu Barbalho-Moulim

    2011-01-01

    Full Text Available OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group or usual care (control group. MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure - maximal inspiratory pressure and maximal expiratory pressure, lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

  8. The Role of Bronchoscopic Therapy in Bronchial Granular Cell Myoblastoma: Presentation of Three Cases

    Directory of Open Access Journals (Sweden)

    C. L. van Felius

    1996-01-01

    Full Text Available Tracheobronchial granular cell myoblastoma (GCM is rare. Although the tumor has some malignant properties, it is considered benign, and there is no consensus regarding treatment. Three cases are reported here. Bronchoscopic treatment in patients with GCM may be attempted as a first approach in case the tumor is intraluminal.

  9. Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Yongqun Li; Huasong Feng; Zhoushan Nie; Jiguang Meng; Xinmin Ding; Zhihai Han

    2012-01-01

    Objective: In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope. Methods: A total of 64 cases of patients in all suffered from central airway obstruction were observed and treated by applying cryorecanalization after cryosurgery via flexible bronchoscope. Divide the operation into two steps, including cryosurgery and cryorecanalization. Evaluate the therapeutic effect immediately after the treatment, wherein the evaluating indicator includes preoperative and postoperative dyspnea indexes, quality of life score, bronchoscopy, etc. The surgical safety assessment is mainly by observing the risk of bleeding in the surgery. Results: Forty cases (62.5%) has postoperative dyspnea score improved at least one level compared with preoperative dyspnea score, 24 patients (37.5%) have no significant improvement on dyspnea score. Quality of life score (Karnofsky score): preoperative 52 ± 18.7 points, postoperative 70 ± 9.2 points. Bronchoscopy review: complete success in 12 cases (18.8%), partial success in 45 cases (70.3%), no success in 7 cases (12%).89.1% overall clinical efficiency was achieved. In the surgery, the control to bleeding was satisfactory since no severe bleeding, moderate bleeding in 14 cases (21.9%) and mild bleeding in 50 cases (78.1%) were found as well as rigid bronchoscope was free. Conclusion: The central airway obstruction can be immediately relieved by cryorecanalization after cryosurgery via flexible bronchoscope with satisfactory effects and higher surgical safety.

  10. Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

    Directory of Open Access Journals (Sweden)

    Theilig D

    2017-06-01

    Full Text Available Dorothea Theilig,1 Felix Doellinger,1 Alexander Poellinger,1 Vera Schreiter,1 Konrad Neumann,2 Ralf-Harto Hubner31Department of Radiology, Charité Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany; 2Institute of Biometrics and Clinical Epidemiology, Charité Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany; 3Department of Pneumology, Charité Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, GermanyBackground: The degree of interlobar emphysema heterogeneity is thought to play an important role in the outcome of endoscopic lung volume reduction (ELVR therapy of patients with advanced COPD. There are multiple ways one could possibly define interlobar emphysema heterogeneity, and there is no standardized definition.Purpose: The aim of this study was to derive a formula for calculating an interlobar emphysema heterogeneity index (HI when evaluating a patient for ELVR. Furthermore, an attempt was made to identify a threshold for relevant interlobar emphysema heterogeneity with regard to ELVR.Patients and methods: We retrospectively analyzed 50 patients who had undergone technically successful ELVR with placement of one-way valves at our institution and had received lung function tests and computed tomography scans before and after treatment. Predictive accuracy of the different methods for HI calculation was assessed with receiver-operating characteristic curve analysis, assuming a minimum difference in forced expiratory volume in 1 second of 100 mL to indicate a clinically important change.Results: The HI defined as emphysema score of the targeted lobe (TL minus emphysema score of the ipsilateral nontargeted lobe disregarding the middle lobe yielded the best predicative accuracy (AUC =0.73, P=0.008. The HI defined as emphysema score of the TL minus emphysema score of the lung without the TL showed a similarly good predictive accuracy (AUC =0.72, P=0.009. Subgroup

  11. The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Shin, Tae Rim; Oh, Yeon-Mok; Park, Joo Hun; Lee, Keu Sung; Oh, Sunghee; Kang, Dae Ryoung; Sheen, Seungsoo; Seo, Joon Beom; Yoo, Kwang Ha; Lee, Ji-Hyun; Kim, Tae-Hyung; Lim, Seong Yong; Yoon, Ho Il; Rhee, Chin Kook; Choe, Kang-Hyeon; Lee, Jae Seung; Lee, Sang-Do

    2015-10-01

    The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC ≥ 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

  12. Evidence-based spectrum of antimicrobial activity for disinfection of bronchoscopes.

    Science.gov (United States)

    Wendt, Constanze; Kampf, Birgit

    2008-10-01

    Processing of bronchoscopes after a physical examination has to eliminate all micro-organisms that could have contaminated the endoscope and that may harm the following patient. The aim of this analysis is to define those micro-organisms that may contaminate the bronchoscope during the examination and that may cause disease in other patients. Research of literature and analysis of laboratory data. During the passage of the respiratory tract the bronchoscope will be contaminated by the physiological flora of oral cavity, nasopharynx, trachea, bronchi, and pulmonary tissues. Whilst the oral cavity, the nasopharynx and the pharynx are the habitat for a great variety of bacteria the lower respiratory tract is virtually free of micro-organisms. However, in ventilated patients trachea and bronchi can become colonized as the result of bypassing the cleansing effect of the ciliated epithelium. In addition all agents that can cause bronchitis or pneumonia in immunocompromised or otherwise healthy individuals are potential contaminants of bronchoscopes. These microorganisms include bacteria, mycobacteria, yeasts and moulds, enveloped and non-enveloped viruses and rarely parasites. The bronchoscopic procedure can result in epithelial injury with subsequent bleeding. Therefore, all blood-borne pathogens, e.g. HIV or HBV are also potential contaminants of the bronchoscope. There are several reports of transmission of micro-organisms due to incomplete or faulty cleaning and disinfection procedures of bronchoscopes. These incidents include nearly all classes of micro-organisms but not parasites or viruses. However, the incubation period of viruses can be long and the association between bronchoscopy and infection may be obscure. Endospore forming micro-organisms and parasites are not part of the normal flora of the respiratory tract and may rarely cause disease, usually only in severely immunocompromised patients, but transmission of such organisms by bronchoscopy has never been

  13. Overweight Is an Independent Risk Factor for Reduced Lung Volumes in Myotonic Dystrophy Type 1

    NARCIS (Netherlands)

    Seijger, Charlotte G W; Drost, Gea; Posma, Joram M; van Engelen, Baziel G M; Heijdra, Yvonne F

    2016-01-01

    BACKGROUND: In this large observational study population of 105 myotonic dystrophy type 1 (DM1) patients, we investigate whether bodyweight is a contributor of total lung capacity (TLC) independent of the impaired inspiratory muscle strength. METHODS: Body composition was assessed using the combinat

  14. Calculation of Lung Cancer Volume of Target Based on Thorax Computed Tomography Images using Active Contour Segmentation Method for Treatment Planning System

    Science.gov (United States)

    Patra Yosandha, Fiet; Adi, Kusworo; Edi Widodo, Catur

    2017-06-01

    In this research, calculation process of the lung cancer volume of target based on computed tomography (CT) thorax images was done. Volume of the target calculation was done in purpose to treatment planning system in radiotherapy. The calculation of the target volume consists of gross tumor volume (GTV), clinical target volume (CTV), planning target volume (PTV) and organs at risk (OAR). The calculation of the target volume was done by adding the target area on each slices and then multiply the result with the slice thickness. Calculations of area using of digital image processing techniques with active contour segmentation method. This segmentation for contouring to obtain the target volume. The calculation of volume produced on each of the targets is 577.2 cm3 for GTV, 769.9 cm3 for CTV, 877.8 cm3 for PTV, 618.7 cm3 for OAR 1, 1,162 cm3 for OAR 2 right, and 1,597 cm3 for OAR 2 left. These values indicate that the image processing techniques developed can be implemented to calculate the lung cancer target volume based on CT thorax images. This research expected to help doctors and medical physicists in determining and contouring the target volume quickly and precisely.

  15. Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques.

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    Full Text Available There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2 and arterial carbon dioxide partial pressure (PaCO2 during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2 monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries.Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis.Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05.PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.

  16. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

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    Sugiura Yasoo

    2013-02-01

    Full Text Available Abstract Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA. When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at Conclusion We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

  17. Effect of lung volume on airway luminal area assessed by computed tomography in chronic obstructive pulmonary disease.

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    Kenta Kambara

    Full Text Available BACKGROUND: Although airway luminal area (Ai is affected by lung volume (LV, how is not precisely understood. We hypothesized that the effect of LV on Ai would differ by airway generation, lung lobe, and chronic obstructive pulmonary disease (COPD severity. METHODS: Sixty-seven subjects (15 at risk, 18, 20, and 14 for COPD stages 1, 2, and 3 underwent pulmonary function tests and computed tomography scans at full inspiration and expiration (at functional residual capacity. LV and eight selected identical airways were measured in the right lung. Ai was measured at the mid-portion of the 3(rd, the segmental bronchus, to 6(th generation of the airways, leading to 32 measurements per subject. RESULTS: The ratio of expiratory to inspiratory LV (LV E/I ratio and Ai (Ai E/I ratio was defined for evaluation of changes. The LV E/I ratio increased as COPD severity progressed. As the LV E/I ratio was smaller, the Ai E/I ratio was smaller at any generation among the subjects. Overall, the Ai E/I ratios were significantly smaller at the 5(th (61.5% and 6(th generations (63.4% and than at the 3(rd generation (73.6%, p<0.001 for each, and also significantly lower in the lower lobe than in the upper or middle lobe (p<0.001 for each. And, the Ai E/I ratio decreased as COPD severity progressed only when the ratio was corrected by the LV E/I ratio (at risk v.s. stage 3 p<0.001, stage 1 v.s. stage 3 p<0.05. CONCLUSIONS: From full inspiration to expiration, the airway luminal area shrinks more at the distal airways compared with the proximal airways and in the lower lobe compared with the other lobes. Generally, the airways shrink more as COPD severity progresses, but this phenomenon becomes apparent only when lung volume change from inspiration to expiration is taken into account.

  18. A Temporal Study of Gene Expression in Rat Lung Following Fixed-volume Hemorrhage

    Science.gov (United States)

    2005-09-13

    2000. 2. Abraham E, Bursten S, Shenkar R, Allbee J, Tuder R, Woodson P, Guidot DM, Rice G, Singer JW, and Repine JE. Phosphatidic acid signaling...other immune cells. Other recent research has focused on free radicals, proteinases, and soluble agents in- cluding cytokines, arachidonic acid ...electrophoresis. A reference preparation consisting of equal amounts of RNA pooled from nine organs (liver, lung, kidney, spleen, heart, skeletal muscle

  19. Effects of inspiratory muscle training on lung volumes, respiratory muscle strength, and quality of life in patients with ataxia telangiectasia.

    Science.gov (United States)

    Félix, Erika; Gimenes, Ana Cristina; Costa-Carvalho, Beatriz Tavares

    2014-03-01

    Ataxia telangiectasia (AT) is a genetic syndrome caused by a mutation of chromosome 11. The clinical features are cerebellar ataxia, telangiectasia, and progressive loss of muscular coordination, including an inefficient cough secondary to progression of neurological disease. To evaluate the effects of inspiratory muscle training (IMT) on ventilation, lung volume, dyspnoea, respiratory muscle strength, and quality of life in patients with AT. A longitudinal study was conducted with 11 AT patients and nine healthy volunteers. Ventilometry, subjective sensation of dyspnoea, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and quality of life were assessed before and after a 24-week IMT program. The IMT load used was set at 60% of the MIP, and the training was performed for 20 min daily. Patients with AT had lower height and weight and also had lower respiratory muscle strength and lung volume compared with healthy volunteers. Furthermore, patients with AT showed a significant improvement when pre- and post-IMT were compared for ventilatory pattern: Vt (476.5 ± 135 ml vs. 583.3 ± 66 ml, P = 0.015) and f (23.3 ± 6 rpm vs. 20.4 ± 4 rpm, P = 0.018), and VC (1,664 ± 463 ml/kg vs. 2,145 ± 750 ml/kg, P = 0.002). IMT also significantly improved the sensation of dyspnoea (median 0.5; minimum 0; maximum 1.0; P = 0.022) and respiratory muscle strength: MIP (-22.2 ± 2 cmH2O vs. -38 ± 9 cmH2O, P < 0.001) and MEP (29 ± 7 cmH2O vs. 40 ± 8 cmH2O, P = 0.001). The health and vitality domains of the SF-36 also showed significant improvement (P = 0.009 and P = 0.014, respectively) post-IMT. IMT was effective in improving ventilatory pattern, lung volume, respiratory muscle strength, and the health and vitality domains for quality of life in patients with AT. IMT may be an effective adjunct therapy to drug treatment for patients with AT. © 2013 Wiley Periodicals, Inc.

  20. EFFECTS OF A BASKETBALL ACTIVITY ON LUNG CAPILLARY BLOOD VOLUME AND MEMBRANE DIFFUSING CAPACITY, MEASURED BY NO/CO TRANSFER IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Rim Dridi

    2006-09-01

    Full Text Available In both children and adults, acute exercise increases lung capillary blood volume (Vc and membrane factor (DmCO. We sought to determine whether basketball training affected this adaptation to exercise in children. The purpose of this study was to determine the effects of two years sport activity on the components of pulmonary gas transfer in children. Over a 2-yr period, we retested 60 nine year old boys who were initially separated in two groups: 30 basketball players (P (9.0 ± 1.0 yrs; 35.0 ± 5.2 kg; 1.43 ± 0.05 m, and matched non players controls (C (8.9 ± 1.0 yrs; 35.0 ± 6.0 kg; 1.44 ± 0.06 m who did not perform any extracurricular activity, Vc and DmCO were measured by the NO/CO transfer method at rest and during sub-maximal exercise. Maximal aerobic power and peak power output was 12% higher in the trained group compared to matched controls (p < 0.05. Nitric oxide lung transfer (TLNO per unit lung volume and thus, DmCO per unit of lung volume (VA were higher at rest and during exercise in the group which had undergone regular basketball activity compared to matched controls (p < 0.05. Neither lung capillary blood volume nor total lung transfer for carbon monoxide (TLCO were significantly different between groups. These results suggest that active sport can alter the properties of the lung alveolo-capillary membrane by improving alveolar membrane conductance in children

  1. Dependence of lung injury on inflation rate during low-volume ventilation in normal open-chest rabbits.

    Science.gov (United States)

    D'Angelo, Edgardo; Pecchiari, Matteo; Saetta, Marina; Balestro, Elisabetta; Milic-Emili, Joseph

    2004-07-01

    Lung mechanics and morphometry were assessed in two groups of nine normal open-chest rabbits mechanically ventilated (MV) for 3-4 h at zero end-expiratory pressure (ZEEP) with physiological tidal volumes (Vt; 11 ml/kg) and high (group A) or low (group B) inflation flow (44 and 6.1 ml x kg(-1) x s(-1), respectively). Relative to initial MV on positive end-expiratory pressure (PEEP; 2.3 cmH(2)O), MV on ZEEP increased quasi-static elastance and airway and viscoelastic resistance more in group A (+251, +393, and +225%, respectively) than in group B (+180, +247, and +183%, respectively), with no change in viscoelastic time constant. After restoration of PEEP, quasi-static elastance and viscoelastic resistance returned to control, whereas airway resistance, still relative to initial values, remained elevated more in group A (+86%) than in group B (+33%). In contrast, prolonged high-flow MV on PEEP had no effect on lung mechanics of seven open-chest rabbits (group C). Gas exchange on PEEP was equally preserved in all groups, and the lung wet-to-dry ratios were normal. Relative to group C, both groups A and B had an increased percentage of abnormal alveolar-bronchiolar attachments and number of polymorphonuclear leukocytes in alveolar septa, the latter being significantly larger in group A than in group B. Thus prolonged MV on ZEEP with cyclic opening-closing of peripheral airways causes alveolar-bronchiolar uncoupling and parenchymal inflammation with concurrent, persistent increase in airway resistance, which are worsened by high-inflation flow.

  2. Interfractional changes in tumour volume and position during entire radiotherapy courses for lung cancer with respiratory gating and image guidance

    DEFF Research Database (Denmark)

    Juhler-Nøttrup, Trine; Korreman, Stine Sofia; Pedersen, Anders N;

    2008-01-01

    measured using a set-up strategy based on imaging of bony landmarks and compared to a strategy using in room lasers, skin tattoos and cupper landmarks. MATERIALS AND METHODS: During their six week treatment course of 60Gy in 2Gy fractions, ten patients underwent 3 respiratory gated CT scans. The tumours...... landmarks and 0.85 cm (+/-0.54) for matching using skin tattoos. For the mediastinal tumours the corresponding vectors and SD's were 0.55 cm (+/-0.19) and 0.72 cm (+/-0.43). The differences between the vectors were significant for the lung tumours p=0.004. The interfractional overlap of lung tumours was 80......-87% when matched using bony landmarks and 70-76% when matched using skin tattoos. The overlap of the mediastinal tumours were 60-65% and 41-47%, respectively. CONCLUSIONS: Despite the use of gating the tumours varied considerably, regarding both position and volume. The variations in position were...

  3. Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center.

    Science.gov (United States)

    Kossakowski, Claudia A; Morresi-Hauf, Alicia; Schnabel, Philipp A; Eberhardt, Ralf; Herth, Felix J F; Warth, Arne

    2014-01-01

    Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction.

  4. Frequency dependence of lung volume changes during superimposed high-frequency jet ventilation and high-frequency jet ventilation.

    Science.gov (United States)

    Sütterlin, R; Priori, R; Larsson, A; LoMauro, A; Frykholm, P; Aliverti, A

    2014-01-01

    Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (ΔEEV(CW)) and gas exchange in relation to variable high frequency. SHFJV or HFJV were used alternatively to ventilate the lungs of 10 anaesthetized pigs (21-25 kg). The low-frequency component was kept at 16 min(-1) in SHFJV. In both modes, high frequencies ranging from 100 to 1000 min(-1) were applied in random order and ventilation was maintained for 5 min in all modalities. Chest wall volume variations were obtained using opto-electronic plethysmography. Airway pressures and arterial blood gases were measured repeatedly. SHFJV increased ΔEEV(CW) compared with HFJV; the difference ranged from 43 to 68 ml. Tidal volume (V(T)) was always >240 ml during SHFJV whereas during HFJV ranged from 92 ml at the ventilation frequency of 100 min(-1) to negligible values at frequencies >300 min(-1). We observed similar patterns for Pa(O₂) and Pa(CO₂). SHFJV provided generally higher, frequency-independent oxygenation (Pa(O₂) at least 32.0 kPa) and CO₂ removal (Pa(CO₂) ∼5.5 kPa), whereas HFJV led to hypoxia and hypercarbia at higher rates (Pa(O₂) 10 kPa at f(HF)>300 min(-1)). In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies ≥300 min(-1).

  5. Prediction of distribution volume of vancomycin in critically ill patients using extravascular lung water and pulmonary vascular permeability indices.

    Science.gov (United States)

    Imaura, Masaharu; Yokoyama, Haruko; Kohyama, Tomoki; Nagafuchi, Hiroyuki; Kohata, Yuji; Takahashi, Hiroyuki; Yamada, Yasuhiko

    2012-11-01

    Alterations in distribution volume affect the concentrations of hydrophilic drugs in plasma and tissues at the time of initial therapy. When the distribution volume of hydrophilic antimicrobials is increased in critically ill patients with a serious infection, antimicrobial concentrations are reduced, which may adversely affect the efficacy of antimicrobial therapy. A transpulmonary thermodilution technique system (PiCCO) enables measurements of pulmonary vascular permeability index (PVPI) and extravascular lung water index (EVLWI), which are related to pulmonary edema and pulmonary vascular permeability, respectively. In addition, those indices may also be related to the distribution volume of hydrophilic antimicrobials. The aim of this study was to investigate the relationships of PVPI and EVLWI with the distribution volume of vancomycin (Vss), as well as to establish a method for estimating Vss for planning an appropriate initial dose for individual patients. Seven patients were administered vancomycin intravenously and underwent extended hemodynamic monitoring with the PiCCO system in the intensive care unit (ICU) from April 2009 to March 2011. Vss was calculated using the Bayesian method, and the relationships of PVPI and EVLWI with Vss were investigated. The relationship between Vss/actual body weight (ABW) and median EVLWI on days when blood levels were measured was significant (r = 0.900, p = 0.0057), whereas the relationship between Vss/ABW and PVPI was not significant (r = 0.649, p = 0.1112). EVLWI determined by the PiCCO system is useful to predict Vss and should lead to more effective vancomycin therapy for critically ill patients at the initial stage.

  6. Lung volume reduction in pulmonary emphysema from the radiologist's perspective; Lungenvolumenreduktion beim Lungenemphysem aus der Sicht des Radiologen

    Energy Technology Data Exchange (ETDEWEB)

    Doellinger, F.; Poellinger, A. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Huebner, R.H. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Internal Medicine/Infectious and Respiratory Diseases; Kuhnigk, J.M. [Fraunhofer MEVIS, Bremen (Germany). Inst. for Medical Image Computing

    2015-08-15

    Pulmonary emphysema causes decrease in lung function due to irreversible dilatation of intrapulmonary air spaces, which is linked to high morbidity and mortality. Lung volume reduction (LVR) is an invasive therapeutical option for pulmonary emphysema in order to improve ventilation mechanics. LVR can be carried out by lung resection surgery or different minimally invasive endoscopical procedures. All LVR-options require mandatory preinterventional evaluation to detect hyperinflated dysfunctional lung areas as target structures for treatment. Quantitative computed tomography can determine the volume percentage of emphysematous lung and its topographical distribution based on the lung's radiodensity. Modern techniques allow for lobebased quantification that facilitates treatment planning. Clinical tests still play the most important role in post-interventional therapy monitoring, but CT is crucial in the detection of postoperative complications and foreshadows the method's high potential in sophisticated experimental studies. Within the last ten years, LVR with endobronchial valves has become an extensively researched minimally-invasive treatment option. However, this therapy is considerably complicated by the frequent occurrence of functional interlobar shunts. The presence of ''collateral ventilation'' has to be ruled out prior to valve implantations, as the presence of these extraanatomical connections between different lobes may jeopardize the success of therapy. Recent experimental studies evaluated the automatic detection of incomplete lobar fissures from CT scans, because they are considered to be a predictor for the existence of shunts. To date, these methods are yet to show acceptable results.

  7. Assessment of minute volume of lung in NPP workers for Korean reference man

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Y. J.; Song, S. H.; Lee, J.; Jin, Y. W.; Yim, Y. K.; Kim, J. S. [KNETEC, Seoul (Korea, Republic of)

    2001-05-01

    To formulation of the reference Korean for radiation protection purpose, we measured the forced vital capacity(FVC), forced expiratory volume in second(FEVI), minute ventilation(MV) of Nuclear Power Plant workers using SP-1 Spirometry Unit(Schiller AG. 1998) and eatimated the liters of breathed for working and resting, also compared these data with ICRP 23.

  8. Mild hypothermia attenuates changes in respiratory system mechanics and modifies cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation.

    Science.gov (United States)

    Dostál, P; Senkeřík, M; Pařízková, R; Bareš, D; Zivný, P; Zivná, H; Cerný, V

    2010-01-01

    Hypothermia was shown to attenuate ventilator-induced lung injury due to large tidal volumes. It is unclear if the protective effect of hypothermia is maintained under less injurious mechanical ventilation in animals without previous lung injury. Tracheostomized rats were randomly allocated to non-ventilated group (group C) or ventilated groups of normothermia (group N) and mild hypothermia (group H). After two hours of mechanical ventilation with inspiratory fraction of oxygen 1.0, respiratory rate 60 min(-1), tidal volume 10 ml x kg(-1), positive end-expiratory pressure (PEEP) 2 cm H2O or immediately after tracheostomy in non-ventilated animals inspiratory pressures were recorded, rats were sacrificed, pressure-volume (PV) curve of respiratory system constructed, bronchoalveolar lavage (BAL) fluid and aortic blood samples obtained. Group N animals exhibited a higher rise in peak inspiratory pressures in comparison to group H animals. Shift of the PV curve to right, higher total protein and interleukin-6 levels in BAL fluid were observed in normothermia animals in comparison with hypothermia animals and non-ventilated controls. Tumor necrosis factor-alpha was lower in the hypothermia group in comparison with normothermia and non-ventilated groups. Mild hypothermia attenuated changes in respiratory system mechanics and modified cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation in animals without previous lung injury.

  9. Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution : A metaanalysis of the literature

    NARCIS (Netherlands)

    Eichhorn, V.; Goepfert, M. S.; Eulenburg, C.; Malbrain, M. L. N. G.; Reuter, D. A.

    2012-01-01

    Introduction: Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680-800 m

  10. Therapeutic bronchoscopic interventions for malignant airway obstruction: A retrospective study from experience on 547 patients.

    Science.gov (United States)

    Dalar, Levent; Özdemir, Cengiz; Abul, Yasin; Karasulu, Levent; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altn, Sedat

    2016-06-01

    There is no definitive consensus about the factors affecting the choice of interventional bronchoscopy in the management of malignant airway obstruction. The present study defines the choice of the interventional bronchoscopic modality and analyzes the factors influencing survival in patients with malignant central airway obstruction. Totally, over 7 years, 802 interventional rigid bronchoscopic procedures were applied in 547 patients having malignant airway obstruction. There was a significant association between the type of stent and the site of the lesion in the present study. Patients with tracheal involvement and/or involvement of the main bronchi had the worst prognosis. The sites of the lesion and endobronchial treatment modality were independent predictors of survival in the present study. The selection of different types of airway stents can be considered on the base of site of the lesion. Survival can be estimated based on the site of the lesion and endobronchial brochoscopic modality used.

  11. Variations in target volume definition for postoperative radiotherapy in stage III non-small-cell lung cancer: analysis of an international contouring study.

    Science.gov (United States)

    Spoelstra, Femke O B; Senan, Suresh; Le Péchoux, Cecile; Ishikura, Satoshi; Casas, Francesc; Ball, David; Price, Allan; De Ruysscher, Dirk; van Sörnsen de Koste, John R

    2010-03-15

    Postoperative radiotherapy (PORT) in patients with completely resected non-small-cell lung cancer with mediastinal involvement is controversial because of the failure of earlier trials to demonstrate a survival benefit. Improved techniques may reduce toxicity, but the treatment fields used in routine practice have not been well studied. We studied routine target volumes used by international experts and evaluated the impact of a contouring protocol developed for a new prospective study, the Lung Adjuvant Radiotherapy Trial (Lung ART). Seventeen thoracic radiation oncologists were invited to contour their routine clinical target volumes (CTV) for 2 representative patients using a validated CD-ROM-based contouring program. Subsequently, the Lung ART study protocol was provided, and both cases were contoured again. Variations in target volumes and their dosimetric impact were analyzed. Routine CTVs were received for each case from 10 clinicians, whereas six provided both routine and protocol CTVs for each case. Routine CTVs varied up to threefold between clinicians, but use of the Lung ART protocol significantly decreased variations. Routine CTVs in a postlobectomy patient resulted in V(20) values ranging from 12.7% to 54.0%, and Lung ART protocol CTVs resulted in values of 20.6% to 29.2%. Similar results were seen for other toxicity parameters and in the postpneumectomy patient. With the exception of upper paratracheal nodes, protocol contouring improved coverage of the required nodal stations. Even among experts, significant interclinician variations are observed in PORT fields. Inasmuch as contouring variations can confound the interpretation of PORT results, mandatory quality assurance procedures have been incorporated into the current Lung ART study. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India

    Science.gov (United States)

    Hibare, Kedar Ravi; Goyal, Rajiv; Nemani, Chetan; Avinash, Rao; Ram, Bajpai; Ullas, Batra

    2017-01-01

    Background: A peripheral, bronchoscopically invisible pulmonary lesion is a diagnostic challenge. Transthoracic needle aspiration has long been the investigation of choice but runs the risk of pneumothorax (up to 44%). Newer technologies like radial endobronchial ultrasound (R-EBUS) offer a safer approach. We present our results of R-EBUS in the diagnosis of bronchoscopically invisible lesions. This is the first large case series from India. Aims: (1) To determine the yield of R-EBUS for the diagnosis of bronchoscopically invisible lesions. (2) To compare the yields of forceps versus cryobiopsies in the diagnosis of these lesions. Setting: Tertiary care cancer center. Design: Prospective study. Methods: Consecutive patients presenting between January and October 2015 with bronchoscopically invisible peripheral pulmonary lesions were included. R-EBUS was used to localize and sample the lesion and the yields were analyzed. Yields of cryo and forceps biopsy were compared where both methods had been used. Data were analyzed using SPSS version 22. Results: A definite diagnosis obtained in 67.3% (37/55) patients with no major complications. No significant difference was found in yield between: (1) small (3 cm) lesions: (46.2% versus 78.6%, P = 0.38). (2) central and adjacent lesions: 61.5% versus 70%. (3) forceps and cryobiopsy (n = 28, 75% versus 67.9% P = 0.562). Conclusions: R-EBUS is a safe procedure in our setting and its yield is comparable to that reported in literature. The yield of central and adjacent lesions and forceps or cryobiopsy appears similar. Further refinements in the technique could improve yield. PMID:28144060

  13. Comparison of haemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus bonfils rigid intubation endoscope

    Directory of Open Access Journals (Sweden)

    Kapil Gupta

    2012-01-01

    Full Text Available Background : The flexible fibreoptic bronchoscope and bonfils rigid intubation endoscope are being widely used for difficult intubations. Methods: The haemodynamic response to intubation under general anaesthesia was studied in 60 adult female patients who were intubated using either flexible fibreoptic bronchoscope or bonfils rigid intubation endoscope (30 in each group. Non-invasive blood pressure and heart rate (HR was recorded before induction of anaesthesia, immediately after induction, at the time of intubation and, thereafter, every minute for the next 5 min. The product of HR and systolic blood pressure (rate pressure product at every point of time was also calculated. Statistical Analyses: Graph pad prism, 5.0 statistical software, independent t test and repeated measure ANOVA test were used. Results: Both bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope required a similar time (less than 1 min for orotracheal intubation. After intubation, there was a significant increase in HR, blood pressure and rate pressure product (P<0.001 in both the groups compared with the baseline and post-induction values. There was no significant difference in HR, blood pressure and rate pressure product at any of the measuring points or in their maximum values during observation between the two groups. The time required for recovery of systolic blood pressure and HR to post-induction value (±10% was not significantly different between the two groups (more than 2 min. Conclusion: In female adults under general anaesthesia, bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope require a similar time for successful orotracheal intubation and cause a similar magnitude of haemodynamic response.

  14. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Kundan Sandugir Gosavi

    2015-06-01

    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  15. [Metastatic characteristics of lymph node in supraclavicular zone and radiotherapy target volume for limited-stage small cell lung cancer].

    Science.gov (United States)

    Feng, Zhen-xing; Zhao, Lu-jun; Guan, Yong; Sun, Yao; Ji, Kai; Wang, Ping

    2013-05-21

    To explore the reasonable radiotherapy range by analyzing the characteristics of supraclavicular lymph node metastasis in limited-stage small cell lung cancer (LS-SCLC). From January 2005 to December 2011, patients of LS-SCLC were reviewed. Supraclavicular zone was further divided into five subgroups including para-recurrent laryngeal nerve (region I and region II ), para-internal jugular vein (region III ), supraclavicular region (region IV), as well as the other regions except for the mentioned above (region V). The characteristics of the lymph nodes in each region were analyzed. The supraclavicular lymph node metastasis was found in 60 patients, with a positive rate of 34.5%. In multivariate Logistic regression analysis,intra-thoracic lymph node metastasis in the lymph node stations of level 2 and 3 were found to be the risk factors of supraclavicular lymph node metastasis (P = 0.006,P = 0.000). Our data suggests that the frequencies of metastasis in region I and III were much higher than those in the other areas.Among the sixty patients with supraclavicular lymph node metastasis, 95.0% were found at region I or III while the incidence of skip metastasis was only 5.0%. It is advisable to contain the bilateral supraclavicular nodes in patients with mediastinal lymph nodes metastasis to the level 2 or 3 for elective radiation target volume.The clinical target volume (CTV) exterior margin containing the outer margin of internal jugular vein may be suitable.

  16. [Measurement of the Minimum Pressure in the Bronchial Cuff during One-lung Ventilation Using a Capnometer].

    Science.gov (United States)

    Okubo, Haruka; Kawasaki, Takashi; Shibayama, Aiko; Sata, Takeyoshi

    2015-08-01

    It is recommended to avoid overinflation of the bronchial cuff, leading to ischemic pressure damages to the respiratory mucosa and bronchial rupture. We investigated the minimum bronchial cuff pressure of 35 Fr double lumen tubes (DLTs) during one lung ventilation using a capnometer. We studied 50 patients who were scheduled to undergo thoracic surgery. General anesthesia was induced and the patients were intubated with 35 Fr left DLT. With a fiberoptic bronchoscope, the DLT was positioned appropriately. The bronchial cuff was inflated first with air 3-3.5 ml. Lung isolation was confirmed by auscultation. Measurements were performed with the patient in the lateral position. Ventilating one lung isolatedly for 5 minutes, we confirmed non ventilated condition with a capnometer displaying flat line. The bronchial cuff was deflated 0.5-ml steps just before displaying the respiratory pattern by the capnogram. The bronchial cuff pressure and volume were recorded at this point The minimum pressures of bronchial cuff (volume) for one lung ventilation are for male 5.46 ± 0.6 cmH2O (2.33?0.1 ml) and for female 1.5?0.5 cmH20 (1.09 ± 0.3 ml). These values are smaller than the recommended value (< 25 cmH2O). There was no case in which the collapse of the operated lung was insufficient. In this study, the bronchial pressure higher than 12 cmH2O was not necessary for one lung ventilation. If high intracuff pressure is necessary to seal the bronchus, there are possibilities of the incompatibility of the size of DLT and the herniation of the bronchial cuff to the proximal side. The method of confirmation of OLV using a capnometer can display the non ventilated condition on the monitor objectively. We can thus decrease troubles during operations.

  17. Tidal volume single breath washout of two tracer gases--a practical and promising lung function test.

    Directory of Open Access Journals (Sweden)

    Florian Singer

    Full Text Available BACKGROUND: Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI, which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW of sulfur hexafluoride (SF(6 and helium (He using an ultrasonic flowmeter (USFM. METHODS: The tracer gas mixture contained 5% SF(6 and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC, were determined in seven subjects performing three SBW 24 hours apart. RESULTS: USFM reliably measured MM during all SBW tests (n = 60. MM from USFM reflected SF(6 and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%. CONCLUSION: The USFM accurately measured relative changes in SF(6 and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF(6 and He washout patterns during tidal breathing.

  18. The Impact of Homogeneous Versus Heterogeneous Emphysema on Dynamic Hyperinflation in Patients With Severe COPD Assessed for Lung Volume Reduction.

    Science.gov (United States)

    Boutou, Afroditi K; Zoumot, Zaid; Nair, Arjun; Davey, Claire; Hansell, David M; Jamurtas, Athanasios; Polkey, Michael I; Hopkinson, Nicholas S

    2015-01-01

    Dynamic hyperinflation (DH) is a pathophysiologic hallmark of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to investigate the impact of emphysema distribution on DH during a maximal cardiopulmonary exercise test (CPET) in patients with severe COPD. This was a retrospective analysis of prospectively collected data among severe COPD patients who underwent thoracic high-resolution computed tomography, full lung function measurements and maximal CPET with inspiratory manouvers as assessment for a lung volume reduction procedure. ΔIC was calculated by subtracting the end-exercise inspiratory capacity (eIC) from resting IC (rIC) and expressed as a percentage of rIC (ΔIC%). Emphysema quantification was conducted at 3 predefined levels using the syngo PULMO-CT (Siemens AG); a difference >25% between best and worse slice was defined as heterogeneous emphysema. Fifty patients with heterogeneous (62.7% male; 60.9 ± 7.5 years old; FEV1% = 32.4 ± 11.4) and 14 with homogeneous emphysema (61.5% male; 62.5 ± 5.9 years old; FEV1% = 28.1 ± 10.3) fulfilled the enrolment criteria. The groups were matched for all baseline variables. ΔIC% was significantly higher in homogeneous emphysema (39.8% ± 9.8% vs.31.2% ± 13%, p = 0.031), while no other CPET parameter differed between the groups. Upper lobe predominance of emphysema correlated positively with peak oxygen pulse, peak oxygen uptake and peak respiratory rate, and negatively with ΔIC%. Homogeneous emphysema is associated with more DH during maximum exercise in COPD patients.

  19. The value of lung scintigraphy in the management of airways foreign bodies in children.

    Science.gov (United States)

    Guanà, R; Gesmundo, R; Maiullari, E; Bianco, E R; Vinardi, S; Cortese, M G; Silvestro, L; Canavese, F

    2009-10-01

    A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age lung scintigraphy in patients' selection. The authors retrospectively reviewed all pediatric bronchoscopies performed by the bronchoscopic team at their Institution from July 2001 to December 2007 in the suspicion of TFB in children scintigraphy positive patients. In the procedure, a 2.7 mm pediatric flexible bronchoscope, passed through the endotracheal tube, was used exclusively for demonstrate and localize TFB and a 3.5-4 mm rigid bronchoscope to extract it. Extraction with the rigid bronchoscope was successful in all cases. The average time of the procedure using both instruments was 46 min (range 35 to 200 minutes). There were no complications associated with any of the procedures in these children. Rigid bronchoscopic extraction of paediatric TFB can be performed safely with minimal risks and complications. Careful patient's' selection remains crucial for choosing candidates to bronchoscopy. In our experience scintigraphic evaluation demonstrated to be of great value in order to have a correct pre-endoscopic diagnosis.

  20. The value of nitrogen washout/washin method in assessing alveolar recruitment volume in acute lung injury patients

    Institute of Scientific and Technical Information of China (English)

    李洋

    2013-01-01

    Objective To evaluate the precision and feasibility of nitrogen washout/washin method in assessing lung recruitment of acute lung injury(ALI)patients.Methods Fifteen ALI patients underwent mechanical ventilation

  1. Lung density

    DEFF Research Database (Denmark)

    Garnett, E S; Webber, C E; Coates, G

    1977-01-01

    The density of a defined volume of the human lung can be measured in vivo by a new noninvasive technique. A beam of gamma-rays is directed at the lung and, by measuring the scattered gamma-rays, lung density is calculated. The density in the lower lobe of the right lung in normal man during quiet...... breathing in the sitting position ranged from 0.25 to 0.37 g.cm-3. Subnormal values were found in patients with emphsema. In patients with pulmonary congestion and edema, lung density values ranged from 0.33 to 0.93 g.cm-3. The lung density measurement correlated well with the findings in chest radiographs...... but the lung density values were more sensitive indices. This was particularly evident in serial observations of individual patients....

  2. Novel muscle and connective tissue design enables high extensibility and controls engulfment volume in lunge-feeding rorqual whales.

    Science.gov (United States)

    Shadwick, Robert E; Goldbogen, Jeremy A; Potvin, Jean; Pyenson, Nicholas D; Vogl, A Wayne

    2013-07-15

    Muscle serves a wide variety of mechanical functions during animal feeding and locomotion, but the performance of this tissue is limited by how far it can be extended. In rorqual whales, feeding and locomotion are integrated in a dynamic process called lunge feeding, where an enormous volume of prey-laden water is engulfed into a capacious ventral oropharyngeal cavity that is bounded superficially by skeletal muscle and ventral groove blubber (VGB). The great expansion of the cavity wall presents a mechanical challenge for the physiological limits of skeletal muscle, yet its role is considered fundamental in controlling the flux of water into the mouth. Our analyses of the functional properties and mechanical behaviour of VGB muscles revealed a crimped microstructure in an unstrained, non-feeding state that is arranged in parallel with dense and straight elastin fibres. This allows the muscles to accommodate large tissue deformations of the VGB yet still operate within the known strain limits of vertebrate skeletal muscle. VGB transverse strains in routine-feeding rorquals were substantially less than those observed in dead ones, where decomposition gas stretched the VGB to its elastic limit, evidence supporting the idea that eccentric muscle contraction modulates the rate of expansion and ultimate size of the ventral cavity during engulfment.

  3. Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker

    Directory of Open Access Journals (Sweden)

    Ahmed A Aljohaney

    2016-01-01

    Full Text Available There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention.

  4. Fluorescent microscopy and Ziehl-Neelsen staining of bronchoalveolar lavage, bronchial washings, bronchoscopic brushing and post bronchoscopic sputum along with cytological examination in cases of suspected tuberculosis

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Bodal

    2015-01-01

    Full Text Available Objectives: Ever since the discovery of Mycobacterium tuberculosis in 1882, many diagnostic methods have been developed. However "The gold standard" for the diagnosis of tuberculosis (TB is still the demonstration of acid fast Bacilli (AFB by microscopic examination of smear or bacteriological confirmation by culture method. Materials and Methods: In suspected 75 patients with active pulmonary TB, the materials obtained bronchoscopically, were bronchoalveolar lavage (BAL, bronchial brushings, bronchial washings and post bronchoscopic sputum. Four smears were made from each of the specimen. Fluorescent Staining, Ziehl–Neelsen (ZN, Pap and May Grunwald-Giemsa (MGG stains were carried out for cytological examination. Results: Fluorescent stain yielded maximum AFB positivity in all the methods, that is 36 (48% in post fibre-optic bronchoscopy (FOB sputum and 19 (25.33% by fluorescence microscopy in both bronchial brushings and bronchial washings. Maximum yield of AFB with ZN staining 12 (16% was equal to the post FOB sputum and bronchial brushings samples. It was followed by 6 cases (8% in BAL and 4 (5.3% in bronchial washings. The cytological examination was suggestive of TB in only 8 (10.66% cases in bronchial washings and 6 (8% cases in post FOB collection. It was equal in BAL and Bronchial brushings each that is 5 (6.67%. Conclusion: Bronchoscopy is a useful diagnostic tool and fluorescent microscopy is more sensitive than ZN and cytology. On X-ray examination, other diseases like malignancy or fungus can also mimick TB. So apart from ZN staining or fluorescence microscopy, Pap and MGG stain will be worthwhile to identify other microorganisms.

  5. Improved CT-based estimate of pulmonary gas trapping accounting for scanner and lung-volume variations in a multicenter asthmatic study.

    Science.gov (United States)

    Choi, Sanghun; Hoffman, Eric A; Wenzel, Sally E; Castro, Mario; Lin, Ching-Long

    2014-09-15

    Lung air trapping is estimated via quantitative computed tomography (CT) using density threshold-based measures on an expiration scan. However, the effects of scanner differences and imaging protocol adherence on quantitative assessment are known to be problematic. This study investigates the effects of protocol differences, such as using different CT scanners and breath-hold coaches in a multicenter asthmatic study, and proposes new methods that can adjust intersite and intersubject variations. CT images of 50 healthy subjects and 42 nonsevere and 52 severe asthmatics at total lung capacity (TLC) and functional residual capacity (FRC) were acquired using three different scanners and two different coaching methods at three institutions. A fraction threshold-based approach based on the corrected Hounsfield unit of air with tracheal density was applied to quantify air trapping at FRC. The new air-trapping method was enhanced by adding a lung-shaped metric at TLC and the lobar ratio of air-volume change between TLC and FRC. The fraction-based air-trapping method is able to collapse air-trapping data of respective populations into distinct regression lines. Relative to a constant value-based clustering scheme, the slope-based clustering scheme shows the improved performance and reduced misclassification rate of healthy subjects. Furthermore, both lung shape and air-volume change are found to be discriminant variables for differentiating among three populations of healthy subjects and nonsevere and severe asthmatics. In conjunction with the lung shape and air-volume change, the fraction-based measure of air trapping enables differentiation of severe asthmatics from nonsevere asthmatics and nonsevere asthmatics from healthy subjects, critical for the development and evaluation of new therapeutic interventions.

  6. Chest wall volume receiving >30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy.

    Science.gov (United States)

    Dunlap, Neal E; Cai, Jing; Biedermann, Gregory B; Yang, Wensha; Benedict, Stanley H; Sheng, Ke; Schefter, Tracey E; Kavanagh, Brian D; Larner, James M

    2010-03-01

    To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving >or=20, >or=30, >or=40, >or=50, and >or=60 Gy was determined and related to the risk of CW toxicity. Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R(2) = 0.9552). A volume threshold of 30 cm(3) was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm(3) receiving 30 Gy. The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm(3), if possible, to reduce the risk of toxicity without compromising tumor coverage. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  7. Efficacy evaluation of retrospectively applying the Varian normal breathing predictive filter for volume definition and artifact reduction in 4D CT lung patients.

    Science.gov (United States)

    Malone, Ciaran; Rock, Luke; Skourou, Christina

    2014-05-08

    Phase-based sorting of four-dimensional computed tomography (4D CT) datasets is prone to image artifacts due to patient's breathing irregularities that occur during the image acquisition. The purpose of this study is to investigate the effect of the Varian normal breathing predictive filter (NBPF) as a retrospective phase-sorting parameter in 4D CT. Ten 4D CT lung cancer datasets were obtained. The volumes of all tumors present, as well as the total lung volume, were calculated on the maximum intensity projection (MIP) images as well as each individual phase image. The NBPF was varied retrospectively within the available range, and changes in volume and image quality were recorded. The patients' breathing trace was analysed and the magnitude and location of any breathing irregularities were correlated to the behavior of the NBPF. The NBPF was found to have a considerable effect on the quality of the images in MIP and single-phase datasets. When used appropriately, the NBPF is shown to have the ability to account for and correct image artifacts. However, when turned off (0%) or set above a critical level (approximately 40%), it resulted in erroneous volume reconstructions with variations in tumor volume up to 26.6%. Those phases associated with peak inspiration were found to be more susceptible to changes in the NBPF. The NBPF settings selected prior to exporting the breathing trace for patients evaluated using 4D CT directly affect the accuracy of the targeting and volume estimation of lung tumors. Recommendations are made to address potential errors in patient anatomy introduced by breathing irregularities, specifically deep breath or cough irregularities, by implementing the proper settings and use of this tool.

  8. Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

    OpenAIRE

    Marcela Cangussu Barbalho-Moulim; Gustavo Peixoto Soares Miguel; Eli Maria Pazzianotto Forti; Flavio do Amaral Campos; Dirceu Costa

    2011-01-01

    OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle trainin...

  9. Evaluation of residual functional lung volume on Tc-99m DTPA aerosol ventilation and Tc-99m MAA perfusion scintigraphy in primary ciliary dyskinesia (Kartagener syndrome).

    Science.gov (United States)

    Chen, Yu-Wen; Chang, Chin-Chuan; Lai, Yung-Chuang; Lu, Chia-Ying; Dai, Zen-Kong

    2008-12-01

    Kartagener syndrome is diagnosed as sinusitis, bronchitis (bronchiectasis), and situs inversus by the clinical features. It is a subclass of primary ciliary dyskinesia (PCD) disease. A 12-year-old girl who had frequent upper and lower airway infections since birth, which was confirmed as Kartagener syndrome by HRCT imaging. We present the residual functional lung volume and mucociliary clearance findings seen on Tc-99m DTPA aerosol ventilation and Tc-99m MAA perfusion scintigraphy.

  10. Modeling of Non-Small Cell Lung Cancer Volume Changes during CT-Based Image Guided Radiotherapy: Patterns Observed and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Hiram A. Gay

    2013-01-01

    Full Text Available Background. To characterize the lung tumor volume response during conventional and hypofractionated radiotherapy (RT based on diagnostic quality CT images prior to each treatment fraction. Methods. Out of 26 consecutive patients who had received CT-on-rails IGRT to the lung from 2004 to 2008, 18 were selected because they had lung lesions that could be easily distinguished. The time course of the tumor volume for each patient was individually analyzed using a computer program. Results. The model fits of group L (conventional fractionation patients were very close to experimental data, with a median Δ% (average percent difference between data and fit of 5.1% (range 3.5–10.2%. The fits obtained in group S (hypofractionation patients were generally good, with a median Δ% of 7.2% (range 3.7–23.9% for the best fitting model. Four types of tumor responses were observed—Type A: “high” kill and “slow” dying rate; Type B: “high” kill and “fast” dying rate; Type C: “low” kill and “slow” dying rate; and Type D: “low” kill and “fast” dying rate. Conclusions. The models used in this study performed well in fitting the available dataset. The models provided useful insights into the possible underlying mechanisms responsible for the RT tumor volume response.

  11. SU-E-J-123: Assessing Segmentation Accuracy of Internal Volumes and Sub-Volumes in 4D PET/CT of Lung Tumors Using a Novel 3D Printed Phantom

    Energy Technology Data Exchange (ETDEWEB)

    Soultan, D [University of California-San Diego, San Diego State University, La Jolla, CA (United States); Murphy, J; James, C; Hoh, C; Moiseenko, V; Cervino, L [University of California, San Diego, La Jolla, CA (United States); Gill, B [British Columbia Cancer Agency, Windsor, ON (Canada)

    2015-06-15

    Purpose: To assess the accuracy of internal target volume (ITV) segmentation of lung tumors for treatment planning of simultaneous integrated boost (SIB) radiotherapy as seen in 4D PET/CT images, using a novel 3D-printed phantom. Methods: The insert mimics high PET tracer uptake in the core and 50% uptake in the periphery, by using a porous design at the periphery. A lung phantom with the insert was placed on a programmable moving platform. Seven breathing waveforms of ideal and patient-specific respiratory motion patterns were fed to the platform, and 4D PET/CT scans were acquired of each of them. CT images were binned into 10 phases, and PET images were binned into 5 phases following the clinical protocol. Two scenarios were investigated for segmentation: a gate 30–70 window, and no gating. The radiation oncologist contoured the outer ITV of the porous insert with on CT images, while the internal void volume with 100% uptake was contoured on PET images for being indistinguishable from the outer volume in CT images. Segmented ITVs were compared to the expected volumes based on known target size and motion. Results: 3 ideal breathing patterns, 2 regular-breathing patient waveforms, and 2 irregular-breathing patient waveforms were used for this study. 18F-FDG was used as the PET tracer. The segmented ITVs from CT closely matched the expected motion for both no gating and gate 30–70 window, with disagreement of contoured ITV with respect to the expected volume not exceeding 13%. PET contours were seen to overestimate volumes in all the cases, up to more than 40%. Conclusion: 4DPET images of a novel 3D printed phantom designed to mimic different uptake values were obtained. 4DPET contours overestimated ITV volumes in all cases, while 4DCT contours matched expected ITV volume values. Investigation of the cause and effects of the discrepancies is undergoing.

  12. Impacted Sharp Oesophageal Foreign Bodies—A Novel Technique of Removal with the Paediatric Bronchoscope

    Science.gov (United States)

    Bajpai, Minu

    2016-01-01

    Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl. PMID:26851436

  13. Impacted Sharp Oesophageal Foreign Bodies--A Novel Technique of Removal with the Paediatric Bronchoscope.

    Science.gov (United States)

    Mitra, Aparajita; Bajpai, Minu

    2016-04-01

    Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl.

  14. A Prospective Randomized Study of the Radiotherapy Volume for Limited-stage Small Cell Lung Cancer: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Xiao HU

    2010-07-01

    Full Text Available Background and objective Controversies exists with regard to target volumes as far as thoracic radiotherapy (TRT is concerned in the multimodality treatment for limited-stage small cell lung cancer (LSCLC. The aim of this study is to prospectively compare the local control rate, toxicity profiles, and overall survival (OS between patients received different target volumes irradiation after induction chemotherapy. Methods LSCLC patients received 2 cycles of etoposide and cisplatin (EP induction chemotherapy and were randomly assigned to receive TRT to either the post- or pre-chemotherapy tumor extent (GTV-T as study arm and control arm, CTV-N included the positive nodal drainage area for both arms. One to 2 weeks after induction chemotherapy, 45 Gy/30 Fx/19 d TRT was administered concurrently with the third cycle of EP regimen. After that, additional 3 cycles of EP consolidation were administered. Prophylactic cranial irradiation (PCI was administered to patients with a complete response. Results Thirty-seven and 40 patients were randomly assigned to study arm and control arm. The local recurrence rates were 32.4% and 28.2% respectively (P=0.80; the isolated nodal failure (INF rate were 3.0% and 2.6% respectively (P=0.91; all INF sites were in the ipsilateral supraclavicular fossa. Medastinal N3 disease was the risk factor for INF (P=0.02, OR=14.13, 95%CI: 1.47-136.13. During radiotherapy, grade I, II weight loss was observed in 29.4%, 5.9% and 56.4%, 7.7% patients respectively (P=0.04. Grade 0-I and II-III late pulmonary injury was developed in 97.1%, 2.9% and 86.4%, 15.4% patients respectively (P=0.07. Median survival time was 22.1 months and 26.9 months respectively. The 1 to 3-year OS were 77.9%, 44.4%, 37.3% and 75.8%, 56.3%, 41.7% respectively (P=0.79. Conclusion The preliminary results of this study indicate that irradiant the post-chemotherapy tumor extent (GTV-T and positive nodal drainage area did not decrease local control and overall

  15. Added value of lung perfused blood volume images using dual-energy CT for assessment of acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Munemasa, E-mail: radokada@yamaguchi-u.ac.jp [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Kunihiro, Yoshie [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Nakashima, Yoshiteru [Department of Radiology, Yamaguchi Grand Medical Center, Oosaki 77, Hofu, Yamaguchi 747-8511 (Japan); Nomura, Takafumi [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Kudomi, Shohei; Yonezawa, Teppei [Department of Radiology, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Suga, Kazuyoshi [Department of Radiology, St. Hills Hospital, Imamurakita 3-7-18, Ube, Yamaguchi 755-0155 (Japan); Matsunaga, Naofumi [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan)

    2015-01-15

    Purpose: To investigate the added value of lung perfused blood volume (LPBV) using dual-energy CT for the evaluation of intrapulmonary clot (IPC) in patients suspected of having acute pulmonary embolism (PE). Materials and methods: Institutional review board approval was obtained for this retrospective study. Eighty-three patients suspected of having PE who underwent CT pulmonary angiography (CTPA) using a dual-energy technique were enrolled in this study. Two radiologists who were blinded retrospectively and independently reviewed CTPA images alone and the combined images with color-coded LPBV over a 4-week interval, and two separate sessions were performed with a one-month interval. Inter- and intraobserver variability and diagnostic accuracy were evaluated for each reviewer with receiver operating characteristic (ROC) curve analysis. Results: Values for inter- and intraobserver agreement, respectively, were better for CTPA combined with LPBV (ICC = 0.847 and 0.937) than CTPA alone (ICC = 0.748 and 0.861). For both readers, diagnostic accuracy (area under the ROC curve [A{sub z}]) were also superior, when CTPA alone (A{sub z} = 0.888 [reader 1] and 0.912 [reader 2]) was compared with that after the combination with LPBV images (A{sub z} = 0.966 [reader 1] and 0.959 [reader 2]) (p < 0.001). However, A{sub z} values of both images might not have significant difference in statistics, because A{sub z} value of CTPA alone was high and 95% confidence intervals overlapped in both images. Conclusion: Addition of dual-energy perfusion CT to CTPA improves detection of peripheral IPCs with better interobserver agreement.

  16. Symposium Entitled: Particle Lung Interactions: ’Overload’ Related Phenomena. A Journal of Aerosol Medicine - Deposition, Clearance, and Effects in the Lung. Volume 3, Supplement 1

    Science.gov (United States)

    1991-04-01

    bleomycin. J. Clin. Invest. 78:1150-1154. MURAD. S .. and PINNELL , S.R. 1987 Suppression of fibroblast proliferation and lysyl hydroxylase activity by...82170 SD 143 I 4 W . I~43II 4 - S m O211001gAi M 12100 p9I ’ T 11021000 mI Figure 2. Effect of 24 hr pretreatment with 500 u/al rat y- interferon on TiO2...Fe in the lungs and in other organs could not be ruled out. Hence, neither exclusive particle re- tention in the lungs nor estimates of S (t) were given

  17. Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Abolmaali, Nasreddin; Koch, Arne [Dresden University of Technology, OncoRay - Molecular and Biological Imaging, Medical Faculty Carl Gustav Carus, Dresden (Germany); Goetzelt, Knut; Vogelberg, Christian [University Clinics Carl Gustav Carus, Dresden University of Technology, Clinic and Policlinic for Pediatrics - Pediatric Pulmonology, Dresden (Germany); Hahn, Gabriele [University Clinics Carl Gustav Carus, Dresden University of Technology, Institute and Policlinic for Radiology - Pediatric Radiology, Dresden (Germany); Fitze, Guido [University Clinics Carl Gustav Carus, Dresden University of Technology, Clinic and Policlinic for Pediatric Surgery, Dresden (Germany)

    2010-07-15

    To compare MRI-based functional pulmonary and cardiac measurements in the long-term follow-up of children operated on for left-sided congenital diaphragmatic hernia (CDH) with age- and body size-matched healthy controls. Twelve children who received immediate postnatal surgery for closure of isolated left-sided CDH were included and received basic medical examinations, pulmonary function testing and echocardiography. MRI included measurement of lung volume, ventricular function assessment and velocity-encoded imaging of the pulmonary arteries and was compared with the data for 12 healthy children matched for age and body size. While patients' clinical test results were not suspicious, comparison between the MRI data for patients and those for healthy controls revealed significant differences. In patients, the volumes of the left lungs were increased and the tidal volume was larger on the right side. While the stroke volumes of both ventricles were reduced, heart rate and ejection fraction were increased. Flow, acceleration time and cross-sectional area of the left pulmonary artery were reduced. Functional MRI detected pulmonary and cardiac findings in the late follow-up of CDH children which may be missed by standard clinical methods and might be relevant for decisions regarding late outcome and treatment. (orig.)

  18. Screening and early detection of lung cancer.

    Science.gov (United States)

    Van't Westeinde, Susan C; van Klaveren, Rob J

    2011-01-01

    Lung cancer with an estimated 342,000 deaths in 2008 (20% of total) is the most common cause of death from cancer, followed by colorectal cancer (12%), breast cancer (8%), and stomach cancer (7%) in Europe. In former smokers, the absolute lung cancer risk remains higher than in never-smokers; these data therefore call for effective secondary preventive measures for lung cancer in addition to smoking cessation programs. This review presents and discusses the most recent advances in the early detection and screening of lung cancer.An overview of randomized controlled computerized tomography-screening trials is given, and the role of bronchoscopy and new techniques is discussed. Finally, the approach of (noninvasive) biomarker testing in the blood, exhaled breath, sputum, and bronchoscopic specimen is reviewed.

  19. Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions.

    Science.gov (United States)

    Boonsarngsuk, Viboon; Kanoksil, Wasana; Laungdamerongchai, Sarangrat

    2015-04-01

    There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs). A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques-including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)-were evaluated for the diagnosis. The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (Ptechniques should be performed together.

  20. Volúmenes pulmonares normales en pacientes con fibrosis pulmonar idiopática y enfisema Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema

    Directory of Open Access Journals (Sweden)

    Juan Pablo Casas

    2008-08-01

    pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. Previous reports suggest that when both diseases coexist, pulmonary volumes are compensated and a smaller than expected reduction or even normal lung volumes can be found. We report 4 male patients of 64, 60, 73 and 70 years, all with heavy cigarette smoking history and progressive breathlessness. Three of them had severe limitation in their quality of life. All four showed advanced lung interstitial involvement, at high resolution CT scan, fibrotic changes predominantly in the subpleural areas of lower lung fields and concomitant emphysema in the upper lobes. Emphysema and pulmonary fibrosis was confirmed by open lung biopsy in one patient. The four patients showed normal spirometry and lung volumes with severe compromise of gas exchange and poor exercise tolerance evaluated by 6 minute walk test. Severe pulmonary arterial hypertension was also confirmed in three patients. Normal lung volumes does not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.

  1. Improvement of internal tumor volumes of non-small cell lung cancer patients for radiation treatment planning using interpolated average CT in PET/CT.

    Directory of Open Access Journals (Sweden)

    Yao-Ching Wang

    Full Text Available Respiratory motion causes uncertainties in tumor edges on either computed tomography (CT or positron emission tomography (PET images and causes misalignment when registering PET and CT images. This phenomenon may cause radiation oncologists to delineate tumor volume inaccurately in radiotherapy treatment planning. The purpose of this study was to analyze radiology applications using interpolated average CT (IACT as attenuation correction (AC to diminish the occurrence of this scenario. Thirteen non-small cell lung cancer patients were recruited for the present comparison study. Each patient had full-inspiration, full-expiration CT images and free breathing PET images by an integrated PET/CT scan. IACT for AC in PET(IACT was used to reduce the PET/CT misalignment. The standardized uptake value (SUV correction with a low radiation dose was applied, and its tumor volume delineation was compared to those from HCT/PET(HCT. The misalignment between the PET(IACT and IACT was reduced when compared to the difference between PET(HCT and HCT. The range of tumor motion was from 4 to 17 mm in the patient cohort. For HCT and PET(HCT, correction was from 72% to 91%, while for IACT and PET(IACT, correction was from 73% to 93% (*p<0.0001. The maximum and minimum differences in SUVmax were 0.18% and 27.27% for PET(HCT and PET(IACT, respectively. The largest percentage differences in the tumor volumes between HCT/PET and IACT/PET were observed in tumors located in the lowest lobe of the lung. Internal tumor volume defined by functional information using IACT/PET(IACT fusion images for lung cancer would reduce the inaccuracy of tumor delineation in radiation therapy planning.

  2. Selection and delineation of lymph node target volume for lung cancer conformal radiotherapy. Proposal for standardizing terminology based on surgical experience

    Energy Technology Data Exchange (ETDEWEB)

    Kiricuta, I.C. [Inst. of Radiation Oncology, St. Vincenz Hospital, Limburg/Lahn (Germany)

    2001-08-01

    Purpose: To select and delineate the target volumes for definitive or postoperative radiotherapy for lung cancer. Methods and Materials: The lymphatics of the lung and the dissemination of tumor cells to the intra- and extrathoracic lymph nodes are described. The incidence of involvement of the different lymph node sites in the chest is analyzed. The involvement of the contralateral hilar and/or supraclavicular lymph nodes and the consequences for target volume selection for curative radiotherapy are discussed. CT-based nodal classification and distribution of lymph nodes in the chest in CT-axial slices are presented. The sentinel node concept (SNC) and the preliminary data available for lung cancer are described. Results: A critical review of the current TNM classification for lung cancer and the implications for target volume selection is given. The individual target volume selection and delineation have to be based on clinical and pathological data from large surgical studies and upon the individual pathological and diagnostic patient data. The selection and delineation of the clinical target volumes for definitive and for postoperative radiotherapy, dependent on the lymph node involvement, are presented. Conclusions: Criteria for the selection and delineation of the clinical target volumes for definitive and for postoperative conformal radiotherapy in axial CT slices under consideration of site, size and stage of the lung cancer are described. Recommendations for target volume selection for definitive or postoperative radiotherapy are presented. (orig.) [German] Ziel: Die Selektion und Bestimmung der klinischen Zielvolumina fuer die alleinige oder postoperative Strahlentherapie beim Bronchialkarzinom. Material und Methode: Die Lymphabflusswege der Lunge und das Verteilungsmuster der Tumorzellen in den regionalen Lymphknoten werden beschrieben. Die CT-Klassifikation und die Verteilung der intrathorakalen Lymphknoten werden vorgestellt. Der Befall der einzelnen

  3. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Directory of Open Access Journals (Sweden)

    Jian Zhang

    2013-07-01

    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  4. [Lung hyperinflation after single lung transplantation to treat emphysema].

    Science.gov (United States)

    Samano, Marcos Naoyuki; Junqueira, Jader Joel Machado; Teixeira, Ricardo Henrique de Oliveira Braga; Caramori, Marlova Luzzi; Pêgo-Fernandes, Paulo Manuel; Jatene, Fabio Biscegli

    2010-01-01

    Despite preventive measures, lung hyperinflation is a relatively common complication following single lung transplantation to treat pulmonary emphysema. The progressive compression of the graft can cause mediastinal shift and respiratory failure. In addition to therapeutic strategies such as independent ventilation, the treatment consists of the reduction of native lung volume by means of lobectomy or lung volume reduction surgery. We report two cases of native lung hyperinflation after single lung transplantation. Both cases were treated by means of lobectomy or lung volume reduction surgery.

  5. Comparison of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar: A clinical study

    Directory of Open Access Journals (Sweden)

    Nitesh Gill

    2015-01-01

    Full Text Available Background: Device like fibreoptic bronchoscope is gold standard for difficult intubation situations. It can be performed by both orotracheal and nasotracheal route. But, through nasal route there are more chances of nasal bleeding and pressure necrosis while through oral route there is only one problem, which is clearing of upper airway for bronchoscope. Manoeuvres like jaw thrust and chin lift are very useful in clearing upper airway for bronchoscope. The aim of this study was to compare ease of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar, in terms of need of manoeuvres: Jaw thrust and Chin lift. Materials and Methods: 25 patients in age range 20-50 years, of ASA ΂ - II, and of either sex undergoing elective surgery under general anaesthesia were randomly allocated into each group. There were two groups: Group A (Rigid Cervical Collar and group B (Without Collar. Intubating condition was assessed in between these groups with need of manoeuvres like jaw thrust and chin lift. Quantitative data i.e. age, weight, thyromental distance and sternomental distance were presented as mean value and standard deviation. Intergroup comparison of quantitative data was done by t-test and probability was considered to be significant if less than <0.05. Categorical data i.e. sex, ASA grade, Mallampati grade and need of manoeuvres were presented as number and were compared among groups using Chi-square test. P < 0.05 was considered statistically significant. Results: There was significant (P < 0.05 difference between group A and group B in terms of use of manoeuvres for ease of intubation and clearing upper airway. In group B, need of jaw thrust and chin lift for clearing airway is significantly (P < 0.05 higher than collar group. Conclusion: We concluded that as far as the oral intubation with flexible fibreoptic bronchoscope is concerned, rigid cervical collar is very useful tool for making intubation easier.

  6. Goal-Directed Fluid Therapy Using Stroke Volume Variation Does Not Result in Pulmonary Fluid Overload in Thoracic Surgery Requiring One-Lung Ventilation

    Directory of Open Access Journals (Sweden)

    Sebastian Haas

    2012-01-01

    Full Text Available Background. Goal-directed fluid therapy (GDT guided by functional parameters of preload, such as stroke volume variation (SVV, seems to optimize hemodynamics and possibly improves clinical outcome. However, this strategy is believed to be rather fluid aggressive, and, furthermore, during surgery requiring thoracotomy, the ability of SVV to predict volume responsiveness has raised some controversy. So far it is not known whether GDT is associated with pulmonary fluid overload and a deleterious reduction in pulmonary function in thoracic surgery requiring one-lung-ventilation (OLV. Therefore, we assessed the perioperative course of extravascular lung water index (EVLWI and paO2/FiO2-ratio during and after thoracic surgery requiring lateral thoracotomy and OLV to evaluate the hypothesis that fluid therapy guided by SVV results in pulmonary fluid overload. Methods. A total of 27 patients (group T were enrolled in this prospective study with 11 patients undergoing lung surgery (group L and 16 patients undergoing esophagectomy (group E. Goal-directed fluid management was guided by SVV (SVV 0.05 in EVLWI during the observation period (BL: 7.8 ± 2.5, 24postop: 8.1 ± 2.4 mL/kg. A subgroup analysis for group L and group E also did not reveal significant changes of EVLWI. The paO2/FiO2-ratio decreased significantly during the observation period (group L: BL: 462 ± 140, OLVterm15: 338 ± 112 mmHg; group E: BL: 389 ± 101, 24postop: 303 ± 74 mmHg but remained >300 mmHg except during OLV. Conclusions. SVV-guided fluid management in thoracic surgery requiring lateral thoracotomy and one-lung ventilation does not result in pulmonary fluid overload. Although oxygenation was reduced, pulmonary function remained within a clinically acceptable range.

  7. Cough quality in children: a comparison of subjective vs. bronchoscopic findings

    Directory of Open Access Journals (Sweden)

    Cox Nancy C

    2005-01-01

    Full Text Available Abstract Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1 cough quality (wet/dry and brassy/non-brassy to bronchoscopic findings of secretions and tracheomalacia respectively and, (2 parent's vs clinician's evaluation of the cough quality (wet/dry. Methods Cough quality of children (without a known underlying respiratory disease undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6. Kappa (K statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls enrolled was 2.6 years (IQR 5.7. Parent's assessment of cough quality (wet/dry agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93. When compared to bronchoscopy (bronchoscopic secretion grade 4, clinicians' cough assessment had the highest sensitivity (0.75 and specificity (0.79 and were marginally better than parent(s. The area under the ROC curve was 0.85 (95%CI 0.77–0.92. Intra-observer (K = 1.0 and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94 was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1. Sensitivity and specificity for brassy cough (for tracheomalacia were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86. Conclusions Dry and wet cough in children, as determined by clinicians and

  8. Noninvasive Evaluation of Microscopic Tumor Extensions Using Standardized Uptake Value and Metabolic Tumor Volume in Non-Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Meng Xue; Sun Xindong [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Mu Dianbin [Department of Pathology, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Xing Ligang [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Ma Li [Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Zhang Baijiang [Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Zhao Shuqiang; Yang Guoren [Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China); Kong Fengming [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Yu Jinming, E-mail: yujinmingsd@yahoo.com.cn [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan (China)

    2012-02-01

    Purpose: To prospectively evaluate whether maximal microscopic extensions (MEmax) correlate with maximal standardized uptake value (SUVmax) and metabolic tumor volume (MTV) at 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images in non-small-cell lung cancer (NSCLC). Methods and Materials: Thirty-nine patients with Stage I-IIIA NSCLC underwent surgery after FDG-PET/CT scanning. SUVmax and MTV were calculated on the PET/CT images. The maximum linear distance from the tumor margin to the farthest extent of the tumor in every dimension was measured at the tumor section. The correlations among MEmax, SUVmax, MTV and other clinical pathologic parameters were analyzed. Results: MEmax for all patients had a significant correlation with SUVmax (r = 0.777, p = 0.008) and MTV (r = 0.724, p < 0.001). When expressed in terms of the probability of covering ME with respect to a given margin, we suggested that margins of 1.93 mm, 3.90 mm, and 9.60 mm for SUVmax {<=}5, 5-10, and >10 added to the gross tumor volume would be adequate to cover 95% of ME. Conclusions: This study demonstrated that tumors with high SUVmax and MTV have more MEmax and would therefore require more margin expansion from gross tumor volume to clinical target volume. FDG-PET/CT, especially for SUVmax, is promising and effective and merits additional study in noninvasive delimiting of the clinical target volume margin for NSCLC.

  9. SU-E-J-179: Assessment of Tumor Volume Change and Movement During Stereotactic Body Radiotherapy (SBRT) for Lung Cancer: Is Adaptive Radiation Therapy (ART) Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lee, C; Lee, C [Asan Medical Center, Seoul (Korea, Republic of)

    2015-06-15

    Purpose: Delineation of gross tumor volumes (GTVs) is important for stereotactic body radiotherapy (SBRT). However, tumor volume changes during treatment response. Here, we have investigated tumor volume changes and movement during SBRT for lung cancer, as a means of examining the need for adaptive radiation therapy (ART). Methods: Fifteen tumors in 15 patients with lung cancer were treated with SBRT (total dose: 60 Gy in 4 fractions). GTVs were obtained from cone-beam computed tomography scans (CBCT1–4) taken before each of the 4 fractions was administered. GTVs were delineated and measured by radiation oncologists using a treatment planning system. Variance in the tumor position was assessed between the planning CT and the CBCT images. To investigate the dosimetric effects of tumor volume changes, planning CT and CBCT4 treatment plans were compared using the conformity index (CI), homogeneity index (HI), and Paddick’s index (PCI). Results: The GTV on CBCT1 was employed as a baseline for comparisons. GTV had decreased by a mean of 20.4% (range: 0.7% to 47.2%) on CBCT4. Most patients had smaller GTVs on CBCT4 than on CBCT1. The interfractional shifts of the tumor position between the planning CT and CBCT1–4 were as follows: right-left, −0.4 to 1.3 mm; anterior-posterior, −0.8 to 0.5 mm; and superiorinferior, −0.9 to 1.1 mm. Indices for plans from the planning CT and CBCT4 were as follows: CI = 0.94±0.02 and 1.11±0.03; HI= 1.1±0.02 and 1.10±0.03; and PCI = 1.35±0.16 and 1.11±0.02, respectively. Conclusion: CI, HI, and PCI did not differ between the planning CT and CBCTs. However, daily CBCT revealed a significant decrease in the GTV during lung SBRT. Furthermore, there was an obvious interfractional shift in tumor position. Using ART could potentially lead to a reduced GTV margin and improved regional tumor control for lung cancer patients with significantly decreased GTV.

  10. Diagnostic value of diffuse and peripheral lung lesions by transbronchial lung biopsy

    Institute of Scientific and Technical Information of China (English)

    Shi Zhihong; Wei Xia; Wei Xiaohong; Zhu Bo

    2008-01-01

    Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions. Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions. Results Eighty-nine final diagnosis cases via TBLB only once, the diagnostic rate of double lung diffuse lesions was the highest, [51.06% (24/47)], local non-nodule lesions, nodule lesions, cavity lesions were 33.33%(23/69), 29.91%(35/117), and 28.57%(4/14), respectively. Among 24 diagnostic cases of double lung diffuse lesions, there were 6 cases of pneumonia of pulmonary tuberculosis, 9 cases of lung carcinoma, 7 cases of adenecarcinoma; 6 cases of pneumonia, 2 cases of fungous infection, and 1 case of lung hemosiderusis. The diagnostic yield about 58 cases of local lesions was low, among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%. In 89 cases of peripheral lung lesions with histological diagnosis, lung carcinoma and pulmonary tuberculosis were frequent diseases, which accounted for 86.52%. Conclusion TBLB is a reliable, safe, effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.

  11. Successful flexible bronchoscopic management of a large-sized aspirated partial denture.

    Science.gov (United States)

    Jamshed, Nayer; Madan, Karan; Ekka, Meera; Guleria, Randeep

    2014-03-20

    A 48-year-old male patient presented to the emergency room with a history of chest pain and breathlessness. Chest X-ray demonstrated a large radio-opaque foreign body in relation to the proximal right bronchial tree. The patient subsequently revealed a history of a misplaced denture 4 months previously. Urgent flexible bronchoscopy (FB) examination demonstrated a large partial denture impacted in the right intermediate bronchus, which was removed successfully using a flexible bronchoscope. Although rigid bronchoscopy (RB) is the procedure of choice for large-sized and impacted airway foreign bodies, the present case highlights the utility of FB in airway foreign body removal. In clinically stable patients with foreign body inhalation, FB can be employed initially as it is an outpatient and cost-effective procedure which can obviate the need for administration of general anaesthesia.

  12. Anesthesia for Advanced Bronchoscopic Procedures: State-of-the-Art Review.

    Science.gov (United States)

    Goudra, Basavana G; Singh, Preet Mohinder; Borle, Anuradha; Farid, Nahla; Harris, Kassem

    2015-08-01

    The bronchoscopic procedures have seen a remarkable increase in both numbers and complexity. Although many anesthesia providers have kept pace with the challenge, the practice is varied and frequently suboptimal. Shared airway during bronchoscopy poses unique challenges. The available reviews have tried to address this lacuna; however, these have frequently dealt with the technical aspects of bronchoscopy than anesthetic challenges. The present review provides evidence-based management insights into anesthesia for bronchoscopy-both flexible and rigid. A systematic approach toward pre-procedural evaluation and risk stratification is presented. The possible anatomical and physiological factors that can influence the outcomes are discussed. Pharmacological principles guiding sedation levels and appropriate selection of sedatives form the crux of safe anesthetic management. The newer and safer drugs that can have potential role in anesthesia for bronchoscopy in the near future are discussed. Ventilatory strategies during bronchoscopy for prevention of hypoxia and hypercarbia are emphasized.

  13. Outcomes after Bronchoscopic Procedures for Primary Tracheobronchial Amyloidosis: Retrospective Study of 6 Cases

    Directory of Open Access Journals (Sweden)

    Ihsan Alloubi

    2012-01-01

    Full Text Available Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.

  14. Successful Flexible Bronchoscopic Management of Dynamic Central Airway Obstruction by a Large Tracheal Carcinoid Tumor

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    Vijay Hadda

    2014-01-01

    Full Text Available Typical carcinoid of the trachea presenting as an endoluminal polypoidal mass is a rare occurrence. Herein, we report a case of a 34-year-old female patient who presented with features of central airway obstruction. Flexible bronchoscopy demonstrated a large pedunculated growth arising from the lower end of the trachea near carina which was flopping in and out of the main tracheal lumen and the proximal right bronchus leading to dynamic airway obstruction. Successful electrosurgical excision (using a snare loop of the polypoidal growth was performed using the flexible bronchoscope itself. The patient had immediate relief of airway obstruction and histopathological examination of the polyp demonstrated features of typical carcinoid (WHO Grade I neuroendocrine tumor.

  15. 基于四维CT的肺体积及呼吸运动分析%Four-dimensional CT in the study of lung volume and respiratory movement

    Institute of Scientific and Technical Information of China (English)

    孙宗文; 黄晓延; 包勇; 张黎; 黄劭敏; 樊卫; 陈明; 邓小武

    2008-01-01

    Objective To evaluate the respiratory movement of the both lungs with four-dimensional CT(4DCT), and determine the optimal respiratory phase series CT images for radiation dose calculation. Methods From November 2005 to November 2006,thirty patients with lung cancer who received 4DCT scan were enrolled,including 15 left and 15 right lung cancer cases,25 men and 5 women. The media age was 55 (35-78) years old. After 4DCT scanning, the image was treated with Advantage 4D workstation,and then transmitted into Pinnacle station( Adac 7.4). The both lungs were automatically outlined using Pinnacle station with CT recognition value of-900 to-200 Hu. Then-the same physician examined the unreasonable parts and revised them. After the delineation was completed,the volume of 10 respiratory phases of lung was obtained. Results The average respiratory phase in inspiratory and expiratory phases was 78.87%±2.71% and 26.32%±3.17% in the tumor located lung,77.55%±2.81% and 24.73%±2.55% in the healthy lung. The maximum and minimum mean volume was 106.48%±3.00% and 94.23%±2.78% in the tumor located lung,107.47%±2.43% and 93.65%±2.32% in the healthy lung. The volume at the end of inspiratory and expiratory was 106.43%±3.07% and 94.63%±2.71% in the tumor located lung, 107.37%±4.62% and 93.98%±2.34% in the healthy lung. Conclusions The series CT images scan on 20% ,30% and 80% respiratory phases are reasonable for radiation dose calculation. The maximum and minimum average lung volumes are almost equal to those at the end of inspiratory and expiratory.%目的 应用四维CT(4DCT)评价肺癌患者肺的运动,并初步选择适合进行剂量计算的呼吸时相.方法 选择30例在中山大学肿瘤医院接受4DCT扫描的肺癌患者,左、右肺患者均为15例;男25例、女5例;中位年龄55岁(35~78岁).CT扫描完成后所得到的影像资料经4D软件处理后传至Pinnacle工作站,应用该软件自动勾画功能勾画双侧肺轮廓,自动怪勾画

  16. Long-term Exposure to PM10 and NO2 in Association with Lung Volume and Airway Resistance in the MAAS Birth Cohort

    Science.gov (United States)

    Agius, Raymond M.; de Vocht, Frank; Lindley, Sarah; Gerrard, William; Lowe, Lesley; Belgrave, Danielle; Custovic, Adnan; Simpson, Angela

    2013-01-01

    Background: Findings from previous studies on the effects of air pollution exposure on lung function during childhood have been inconsistent. A common limitation has been the quality of exposure data used, and few studies have modeled exposure longitudinally throughout early life. Objectives: We sought to study the long-term effects of exposure to particulate matter with an aerodynamic diameter ≤ 10 μm (PM10) and to nitrogen dioxide (NO2) on specific airway resistance (sRaw) and forced expiratory volume in 1 sec (FEV1) before and after bronchodilator treatment. Subjects were from the Manchester Asthma and Allergy Study (MAAS) birth cohort (n = 1,185). Methods: Spirometry was performed during clinic visits at ages 3, 5, 8, and 11 years. Individual-level PM10 and NO2 exposures were estimated from birth to 11 years of age through a microenvironmental exposure model. Longitudinal and cross-sectional associations were estimated using generalized estimating equations and multivariable linear regression models. Results: Lifetime exposure to PM10 and NO2 was associated with significantly less growth in FEV1 (percent predicted) over time, both before (–1.37%; 95% CI: –2.52, –0.23 for a 1-unit increase in PM10 and –0.83%; 95% CI: –1.39, –0.28 for a 1-unit increase in NO2) and after bronchodilator treatment (–3.59%; 95% CI: –5.36, –1.83 and –1.20%; 95% CI: –1.97, –0.43, respectively). We found no association between lifetime exposure and sRaw over time. Cross-sectional analyses of detailed exposure estimates for the summer and winter before 11 years of age and lung function at 11 years indicated no significant associations. Conclusions: Long-term PM10 and NO2 exposures were associated with small but statistically significant reductions in lung volume growth in children of elementary-school age. Citation: Mölter A, Agius RM, de Vocht F, Lindley S, Gerrard W, Lowe L, Belgrave D, Custovic A, Simpson A. 2013. Long-term exposure to PM10 and NO2 in

  17. The Diagnosis and Management of Airway Complications Following Lung Transplantation.

    Science.gov (United States)

    Mahajan, Amit K; Folch, Erik; Khandhar, Sandeep J; Channick, Colleen L; Santacruz, Jose F; Mehta, Atul C; Nathan, Steven D

    2017-03-05

    Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2-4 percent. The incidence of lethal and non-lethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplant airway complications is anastomotic ischemia. Airway complications include development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation, and provides our expert opinion where evidence is lacking.

  18. Application of bronchoscopic lung volume reduction using one-way flap device in sheep model of heterogeneous emphysema%纤维支气管镜肺减容术在绵羊肺气肿模型中的应用

    Institute of Scientific and Technical Information of China (English)

    吴琦; 李卫平; 任宝香; 武俊平; 范勇; 梁春宝; 马景良; 李萍; 华静娜; 王咏梅; 王金荣

    2006-01-01

    目的评价使用纤维支气管镜单向活瓣支架肺减容术治疗肺气肿动物模型的疗效和安全性.方法6月龄绵羊6只,全麻下经纤维支气管镜在肺段局部给予木瓜蛋白酶(75 U/kg)后,机械通气15~20 min形成肺气肿模型.通过CT确定靶区后,在X线造影定位并确定靶支气管后,经纤维支气管镜通过导丝和放送装置在肺气肿亚段放入1~2个单向活瓣支架,术后给予3 d抗炎治疗.在术前和术后8周测量肺功能残气量;术后8周处死动物取出完整肺组织,在萎陷区、非萎陷区和对侧正常肺组织分别取材,观察大体及光镜下病理学改变.结果应用纤维支气管镜肺减容术后,动物耐受性较好,术后无明显咳嗽、呼吸困难症状,术后1 h动物即可进食、行走.病理观察无肺部炎症、肺脓肿和肉芽肿形成,2只动物支架处支气管壁少量纤维母细胞和平滑肌及支气管黏膜上皮细胞增生,4只动物未见明显异常.支架远端肺组织大体标本和光镜下均证实存在肺不张,术后肺功能残气量较术前明显降低(降低49.5%),手术过程安全、操作简单易行.结论经纤维支气管镜单向活瓣支架肺减容术治疗肺气肿创伤小,支架对于气管壁的刺激小,可以达到外科肺减容术的效果;所做的动物模型为不均一肺气肿,与人类发病类型很相似,故对进一步行临床研究有一定的参考价值;因术后观察时间仅为8周,支架远期对气道的损伤及其疗效需要进一步研究.

  19. Primary study on bronchoscopic lung volume reduction using one-way flap stent made in China in sheep model of heterogeneous emphysema%国产支架支气管肺减容术在绵羊肺气肿模型中的初步应用

    Institute of Scientific and Technical Information of China (English)

    范勇; 吴琦; 梁春宝; 李萍; 马景良; 武俊平; 华静娜; 王咏梅; 王金荣; 沈淑敏; 贺能树

    2007-01-01

    目的 评价经气道国产单向活瓣支架肺减容术治疗肺气肿动物模型的放送技术和稳定性.方法 应用局部气管内滴注木瓜蛋白酶方法复制6个月龄绵羊不均一肺气肿模型,经纤维支气管镜通过导丝和放送装置在肺气肿亚段放入1、2个单向活瓣支架,术后8周处死动物取出完整肺组织,在萎陷区、非萎陷区和对侧正常肺组织分别取材,观察大体及光镜下病理学改变.结果 7只绵羊气肿模型,共放置支架10支,9支均成功植入.病理观察1只出现肺部炎症细胞浸润,2只植入支架处支气管壁有少量纤维母细胞、平滑肌细胞及支气管粘膜上皮细胞增生,4只未见明显异常.CT检查支架远端、肺组织大体标本和光镜下均证实存在肺不张.结论 经纤维支气管镜植入单向活瓣支架行肺减容术治疗肺气肿创伤小,支架对气管壁的刺激小,可以达到外科肺减容术的效果.

  20. 镜下射频置管肺减容术在肺气肿绵羊的应用%The application of establishing airway bypass by bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

    Institute of Scientific and Technical Information of China (English)

    郭俊华; 路武杰; 冯志军; 黄志昂; 王红燕; 靳建军; 王静

    2014-01-01

    目的 探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法 将16只6个月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,给予内科治疗,B组仅给予常规内科治疗.分别测两组绵羊术前和术后24 h、4周、8周的第1秒用力呼气容积(B超仅衔常规内科治疗,FEV10),且进行比较,A组定期行胸部CT检查,两组动物治疗8周均予以处死,行病理学检查.结果 ①成功复制绵羊肺气肿动物模型16只,A组术中、术后无明显异常;②A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;③两组不同时间点FEV1.水平差异有显著性(F时间=1 352.409,P<0.001),两种治疗手段效果差异有显著性(F组间=5 004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1 325.058,P<0.001);(④病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论 该技术治疗绵羊肺气肿模型具有有效性及优越性.

  1. Correlation of {sup 18}F-FDG Avid Volumes on Pre–Radiation Therapy and Post–Radiation Therapy FDG PET Scans in Recurrent Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shusharina, Nadya, E-mail: nshusharina@partners.org; Cho, Joseph; Sharp, Gregory C.; Choi, Noah C.

    2014-05-01

    Purpose: To investigate the spatial correlation between high uptake regions of 2-deoxy-2-[{sup 18}F]-fluoro-D-glucose positron emission tomography ({sup 18}F-FDG PET) before and after therapy in recurrent lung cancer. Methods and Materials: We enrolled 106 patients with inoperable lung cancer into a prospective study whose primary objectives were to determine first, the earliest time point when the maximum decrease in FDG uptake representing the maximum metabolic response (MMR) is attainable and second, the optimum cutoff value of MMR based on its predicted tumor control probability, sensitivity, and specificity. Of those patients, 61 completed the required 4 serial {sup 18}F-FDG PET examinations after therapy. Nineteen of 61 patients experienced local recurrence at the primary tumor and underwent analysis. The volumes of interest (VOI) on pretherapy FDG-PET were defined by use of an isocontour at ≥50% of maximum standard uptake value (SUV{sub max}) (≥50% of SUV{sub max}) with correction for heterogeneity. The VOI on posttherapy images were defined at ≥80% of SUV{sub max}. The VOI of pretherapy and posttherapy {sup 18}F-FDG PET images were correlated for the extent of overlap. Results: The size of VOI at pretherapy images was on average 25.7% (range, 8.8%-56.3%) of the pretherapy primary gross tumor volume (GTV), and their overlap fractions were 0.8 (95% confidence interval [CI]: 0.7-0.9), 0.63 (95% CI: 0.49-0.77), and 0.38 (95% CI: 0.19-0.57) of VOI of posttherapy FDG PET images at 10 days, 3 months, and 6 months, respectively. The residual uptake originated from the pretherapy VOI in 15 of 17 cases. Conclusions: VOI defined by the SUV{sub max}-≥50% isocontour may be a biological target volume for escalated radiation dose.

  2. Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sae Ah; Kim, Do Hyeong [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of); Jen, Gyeong Sik [Bundang CHA General Hospital, CHA University, Seongnam (Korea, Republic of)

    2012-07-15

    Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

  3. Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope.

    Science.gov (United States)

    Rajendram, R; McGuire, N

    2006-10-01

    Although tracheostomy tube displacement is uncommon, the management is often difficult and the associated mortality is high. It is important to ensure that the airway is secure and then either replace or reposition the tracheostomy tube. This case report describes the use of an Aintree intubation catheter (C-CAE-19.0-56-AIC, William Cook Europe, Denmark) mounted on an intubating fibre-optic bronchoscope (11302BD1, Karl Storz Endoskope, Germany) to reposition a partially displaced tracheostomy tube.

  4. Effete of bronchoscopic cryotherapy and injection treatment on negative sputum conversion and immune function of multi-drug resistant tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Li Li

    2016-01-01

    Objective:To analyze the effect of bronchoscopic cryotherapy and injection treatment on negative sputum conversion and immune function of multi-drug resistant tuberculosis. Methods:A total of 60 patients with multi-drug resistant tuberculosis were randomly divided into observation group and control group, control group received 3DVThAE/15DVThE treatment and observation group received bronchoscopic cryotherapy and injection + 3DVThAE/15DVThE treatment. Differences in negative sputum conversion, serum ADA and inflammatory factors, immune function index values,etc. were compared between two groups after treatment.Results: Negative sputum conversion rate of observation group 6, 12 and 18 months after treatment were higher than those of control group (P<0.05); ADA, CRP and IL-10 levels of observation group after treatment were lower than those of control group, and IFN-γ level was higher than that of control group (P<0.05); peripheral blood CD3+ and CD4+T lymphocyte levels and CD4+/CD8+ ratio were higher than those of control group, and CD8+T lymphocyte level was lower than that of control group (P<0.05); IgA, IgM and IgG levels were higher than those of control group (P<0.05).Conclusions:Bronchoscopic cryotherapy and injection therapy can improve the condition in patients with multidrug-resistant tuberculosis and optimize treatment outcome.

  5. Treatment of Non-Small Cell Lung Cancer (NSCLC) Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

    Institute of Scientific and Technical Information of China (English)

    Yusheng Shi; Xiaogang Deng; Longhua Chen

    2007-01-01

    OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung cancer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, I.e. The dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeutic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks.RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET examination (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547).CONCLUSION The recurrence rate in the lymph nodes beyond the target area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.

  6. Interfractional Positional Variability of Fiducial Markers and Primary Tumors in Locally Advanced Non-Small-Cell Lung Cancer During Audiovisual Biofeedback Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Roman, Nicholas O., E-mail: nroman@mcvh-vcu.edu [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Shepherd, Wes [Department of Pulmonology, Virginia Commonwealth University, Richmond, VA (United States); Mukhopadhyay, Nitai [Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (United States); Hugo, Geoffrey D.; Weiss, Elisabeth [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States)

    2012-08-01

    Purpose: To evaluate implanted markers as a surrogate for tumor-based setup during image-guided lung cancer radiotherapy with audiovisual biofeedback. Methods and Materials: Seven patients with locally advanced non-small-cell lung cancer were implanted bronchoscopically with gold coils. Markers, tumor, and a reference bony structure (vertebra) were contoured for all 10 phases of the four-dimensional respiration-correlated fan-beam computed tomography and weekly four-dimensional cone-beam computed tomography. Results: The systematic/random interfractional marker-to-tumor centroid displacements were 2/3, 2/2, and 3/3 mm in the x (lateral), y (anterior-posterior), and z (superior-inferior) directions, respectively. The systematic/random interfractional marker-to-bone displacements were 2/3, 2/3, and 2/3 mm in the x, y, and z directions, respectively. The systematic/random tumor-to-bone displacements were 2/3, 2/4, and 4/4 mm in the x, y, and z directions, respectively. All displacements changed significantly over time (p < 0.0001). Conclusions: Although marker-based image guidance may decrease the risk for geometric miss compared with bony anatomy-based positioning, the observed displacements between markers and tumor centroids indicate the need for repeated soft tissue imaging, particularly in situations with large tumor volume change and large initial marker-to-tumor centroid distance.

  7. Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Huang Wei

    2011-11-01

    Full Text Available Abstract Objectives We aim to address several clinical interests regarding lung volume reduction surgery (LVRS for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs. Methods Eight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS and video-assisted thoracoscopic surgery (VATS. And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively. Results Odds ratio (95%CI, expressed as the mortality of group A (the group underwent LVRS versus group B (conservative medical therapies, was 5.16(2.84, 9.35 in 3 months, 3(0.94, 9.57 in 6 months, 1.05(0.82, 1.33 in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS. Conclusions LVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.

  8. What Are Lung Function Tests?

    Science.gov (United States)

    ... include tests that measure lung size and air flow, such as spirometry and lung volume tests. Other tests measure how well gases such as oxygen get in and out of your blood. These tests include pulse oximetry and arterial blood ...

  9. A planning study of radiotherapy dose escalation of PET-active tumour volumes in non-small cell lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Sloth Moeller, Ditte; Hoffmann, Lone (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus (Denmark)), e-mail: dittmoel@rm.dk; Khalil, Azza Ahmed; Marquard Knap, Marianne (Dept. of Oncology, Aarhus Univ. Hospital, Aarhus (Denmark)); Muren, Ludvig Paul (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus (Denmark); Dept. of Oncology, Aarhus Univ. Hospital, Aarhus (Denmark))

    2011-08-15

    Background. Patients with non-small cell lung cancer (NSCLC) have poor prognosis partly because of high local failure rates. Escalating the dose to the tumour may decrease the local failure rates and thereby, improve overall survival, but the risk of complications will limit the possibility to dose-escalate a broad range of patients. Escalating only PET-active areas of the tumour may increase the potential for reaching high doses for a variety of tumour sizes and locations. Material and methods. Ten patients were randomly chosen for a dose escalation planning study. A planning target volume (PTV) was defined on the mid-ventilation scan of a four-dimensional computed tomography (4D-CT) scan and a boost planning target volume (PTV-boost) was defined based on a positron emission tomography computed tomography (PET-CT) scan. Treatment plans were created aiming to reach the highest achievable of 74 Gy, 78 Gy or 82 Gy in 2 Gy per fraction prescribed to the PTV-boost without compromising normal tissue constraints and with the PTV prescribed in all cases a biological equivalent dose in 2 Gy fractions of 66 Gy. Results. Nine of ten patients could be escalated to the highest dose level (82 Gy), while one patient was limited by the oesophagus dose constraint and could only reach 74 Gy. Four patients could be dose-escalated above 82 Gy without compromising normal tissue constraints. Conclusion. Dose-escalating only the PET-active areas of lung tumours to doses of 82 Gy while respecting normal tissue constraints is feasible, also in a series of unselected patients including cases with relatively large tumours

  10. Lobar flexible fiberoptic lung lavage: therapeutic benefit in severe respiratory failure in pulmonary alveolar proteinosis and influenza A H1N1 pneumonia

    Directory of Open Access Journals (Sweden)

    Antonello Nicolini

    2011-07-01

    Full Text Available Lobar fiberoptic lung lavage is a well-known procedure used in primary pulmonary alveolar proteinosis (PAP; the use of this procedure has increased in the recent years. This procedure has also been used in other pulmonary diseases such as desquamative interstitial pneumonia with good results. We describe a case of extremely severe respiratory failure due to concurrence of PAP and Influenza A H1N1 virus pneumonia which resolved with the help of this procedure. The patient, a 41- year-old woman, needed less mechanical ventilation after undergoing lobar fiberoptic bronchoscopic lavage. Moreover, a rapid and progressive improvement in the computed tomography of the lungs was observed. Flexibile fiberoptic bronchoscopic lobar lavage is a simple, safe procedure used not only in milder disease, but also in particular severe cases in which the physiological derangement of whole lung lavage would not be tolerated by patient or when extra-corporeal membrane oxygenation is not available.

  11. Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

    NARCIS (Netherlands)

    Salavati, Ali; Borofsky, Samuel; Boon-Keng, Teo K.; Houshmand, Sina; Khiewvan, Benjapa; Saboury, Babak; Codreanu, Ion; Torigian, Drew A.; Zaidi, Habib; Alavi, Abass

    2015-01-01

    Purpose: The aim of this study is to assess a software-based method with semiautomated correction for partial volume effect (PVE) to quantify the metabolic activity of pulmonary malignancies in patients who underwent non-gated and respiratory-gated 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emi

  12. Comparison of internal target volumes defined on 3-dimensional, 4-dimensonal, and cone-beam CT images of non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Li F

    2016-11-01

    Full Text Available Fengxiang Li,1 Jianbin Li,1 Zhifang Ma,1 Yingjie Zhang,1 Jun Xing,1 Huanpeng Qi,1 Dongping Shang21Department of Radiation Oncology, 2Department of Big Bore CT Room, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of ChinaPurpose: The purpose of this study was to compare the positional and volumetric differences of internal target volumes defined on three-dimensional computed tomography (3DCT, four-dimensional CT (4DCT, and cone-beam CT (CBCT images of non-small-cell lung cancer (NSCLC. Materials and methods: Thirty-one patients with NSCLC sequentially underwent 3DCT and 4DCT simulation scans of the thorax during free breathing. The first CBCT was performed and registered to the planning CT using the bony anatomy registration during radiotherapy. The gross tumor volumes were contoured on the basis of 3DCT, maximum intensity projection (MIP of 4DCT, and CBCT. CTV3D (clinical target volume, internal target volumes, ITVMIP and ITVCBCT, were defined with a 7 mm margin accounting for microscopic disease. ITV10 mm and ITV5 mm were defined on the basis of CTV3D: ITV10 mm with a 5 mm margin in left–right (LR, anterior–posterior (AP directions and 10 mm in cranial–caudal (CC direction; ITV5 mm with an isotropic internal margin (IM of 5 mm. The differences in the position, size, Dice’s similarity coefficient (DSC and inclusion relation of different volumes were evaluated.Results: The median size ratios of ITV10 mm, ITV5 mm, and ITVMIP to ITVCBCT were 2.33, 1.88, and 1.03, respectively, for tumors in the upper lobe and 2.13, 1.76, and 1.1, respectively, for tumors in the middle-lower lobe. The median DSCs of ITV10 mm, ITV5 mm, ITVMIP, and ITVCBCT were 0.6, 0.66, and 0.83 for all patients. The median percentages of ITVCBCT not included in ITV10 mm, ITV5 mm, and ITVMIP were 0.1%, 1.63%, and 15.21%, respectively, while the median percentages of ITV10 mm, ITV5 mm

  13. Application of collaborative nursing model in bronchial tuberculosis with cryotherapy by electronic bronchoscope%协同护理模式在支气管镜介入冷冻治疗支气管结核中的应用

    Institute of Scientific and Technical Information of China (English)

    盛莉; 林明贵; 王春梅; 于华丽; 薛娟敏

    2011-01-01

    目的 探讨经支气管镜介入冷冻治疗支气管结核的护理方法。方法 对22例经支气管镜介入局部冷冻治疗的患者实行术前宣教、术中配合、术后护理的协同护理模式,比较治疗前后患者临床症状、镜下表现及影像学检查,患者术前焦虑发生的情况,患者对支气管镜检查治疗知识的知晓程度及患者对支气管镜冷冻治疗的接受程度。结果 22例患者共进行了87次治疗,每例患者平均治疗1.5个月,平均(5±3)次,临床症状改善明显,原气管、支气管内膜病变绝大部分吸收,肺部病变明显吸收,原狭窄的管腔通畅,显效68.18%,有效31.81%,总有效率100%。未见明显不良反应。患者术前平均焦虑评分为(31.45±5.65)分,与常模(29.78±0.46)分比较,差异无统计学意义(t=1.391,P>0.05);对支气管镜冷冻治疗知识的知晓情况,比较了解以上的项目达到了96%,全部患者均愿意接受此项治疗。结论 协同护理模式在支气管镜介入冷冻治疗支气管结核的应用中起到了一定辅助作用,它也是临床上一种新的护理模式,值得临床有条件的单位推广应用及验证。%Objective To investigate collaborative nursing model in bronchial tuberculosis with cryotherapy by electronic bronchoscope. Methods Preoperative education, perioperative coordination and postoperative nursing were adopted in 22 bronchial tuberculosis patients with cryotherapy by electronic bronchoscope. Clinical symptoms, endoscope demonstrations, imaging examination, preoperative anxiety, and knowledge and acceptation degree in patients were evaluated between pre and post treatment. Results All 22 patients were treated with therapy for 87 times. Each patient was treated ( 5 ± 3 ) times, average treatment time was 1.5 months. Clinical symptom was improved, lung lesions were disappeared and lumen patency could be found after treatment. The improvement rate

  14. Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

    Institute of Scientific and Technical Information of China (English)

    Jian Hu; Ximing Xu; Guangjin Yuan; Wei Ge; Liming Xu; Aihua Zhang; Junjian Deng

    2015-01-01

    Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography (kV-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy (IMRT) or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied. kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume (GTV) was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra-phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95%(D95) or 1% (D1) of the planning target volume (PTV), mean lung dose (MLD), and volume of lung tissue that received more than 5 (V5), 10 (V10), 20 (V20), and 30 (V30) Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio-therapy was -25.85% (range, -13.09% --56.76%). The D95 and D1 of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of >20% in the third or fourth week of treatment during IMRT, adap-tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 20% in the third or fourth week of treatment.

  15. Semiautomatic technique for defining the internal gross tumor volume of lung tumors close to liver/spleen cupola by 4D-CT

    Energy Technology Data Exchange (ETDEWEB)

    Mancosu, Pietro; Sghedoni, Roberto; Bettinardi, Valentino; Aquilina, Mark Anthony; Navarria, Piera; Cattaneo, Giovanni Mauro; Di Muzio, Nadia; Cozzi, Luca; Scorsetti, Marta [Department of Radiotherapy, IRCCS Istituto Clinico Humanitas, Rozzano, 20089 Milano (Italy); Department of Medical Physics, Arcispedale S. Maria Nuova, Reggio, 42100 Emilia (Italy); Department of Nuclear Medicine, Scientific Institute H. S. Raffaele, 20089 Milan (Italy); Department of Radiotherapy, IRCCS Istituto Clinico Humanitas, 20089 Rozzano, Milano (Italy); Department of Medical Physics, San Raffaele Scientific Institute, 20133 Milan (Italy); Department of Radiotherapy, San Raffaele Scientific Institute, 20133 Milan (Italy); Medical Physics Unit, Oncology Institute of Southern Switzerland, 6504 Bellinzona (Switzerland); Department of Radiotherapy, IRCCS Istituto Clinico Humanitas, 20089 Rozzano, Milano (Italy)

    2010-09-15

    Purpose: It has been shown that in cases of lung tumors close to the liver cupola, the four dimensional (4D)-CT postprocessing maximum intensity projection (MIP) algorithm does not fully recover the radiotherapy internal gross tumor volume (IGTV). In this work, a semiautomatic technique was evaluated by which the residual IGTV that was not included into the IGTV by MIP algorithm was actually added. Methods: A moving phantom and five selected patients were considered. The various IGTVs produced by the semiautomatic approach were compared to those generated by 4D-CT manual contouring. Results: In all cases, the radiation oncologist qualitatively concurred with the semiautomatic IGTV. A quantitative difference in volume of 2.6% was found in the phantom study, whereas a mean difference of 0.1{+-}4.6% was obtained in the patient studies. Conclusions: A semiautomatic technique to include the residual part of IGTV covered by liver/spleen cupola when using MIP algorithm was validated on phantom and on selected patients, revealing the possibility of defining the IGTV for patients with lesions located near liver/spleen cupola by performing only the contours on the MIP series.

  16. Early treatment volume reduction rate as a prognostic factor in patients treated with chemoradiotherapy for limited stage small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joo Hwan; Lee, Jeong Shin; Lee, Chang Geol; Cho, Jae Ho [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Jin Hyun; Kim, Jun Won [Dept. of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    To investigate the relationship between early treatment response to definitive chemoradiotherapy (CRT) and survival outcome in patients with limited stage small cell lung cancer (LS-SCLC). We retrospectively reviewed 47 patients with LS-SCLC who received definitive CRT between January 2009 and December 2012. Patients were treated with systemic chemotherapy regimen of etoposide/carboplatin (n = 15) or etoposide/cisplatin (n = 32) and concurrent thoracic radiotherapy at a median dose of 54 Gy (range, 46 to 64 Gy). Early treatment volume reduction rate (ETVRR) was defined as the percentage change in gross tumor volume between diagnostic computed tomography (CT) and simulation CT for adaptive RT planning and was used as a parameter for early treatment response. The median dose at adaptive RT planning was 36 Gy (range, 30 to 43 Gy), and adaptive CT was performed in 30 patients (63.8%). With a median follow-up of 27.7 months (range, 5.9 to 75.8 months), the 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 74.2% and 56.5%, respectively. The mean diagnostic and adaptive gross tumor volumes were 117.9 mL (range, 5.9 to 447 mL) and 36.8 mL (range, 0.3 to 230.6 mL), respectively. The median ETVRR was 71.4% (range, 30 to 97.6%) and the ETVRR >45% group showed significantly better OS (p < 0.0001) and LRPFS (p = 0.009) than the other group. ETVRR as a parameter for early treatment response may be a useful prognostic factor to predict treatment outcome in LS-SCLC patients treated with CRT.

  17. Haemophilia, AIDS and lung epithelial permeability

    Energy Technology Data Exchange (ETDEWEB)

    O' Doherty, M.J.; Page, C.J.; Harrington, C.; Nunan, T.; Savidge, G. (Haemophilia Centre and Coagulation Research Unit, Department of Nuclear Medicine, Rayne Institute, St. Thomas' Hospital, London (United Kingdom))

    1990-01-01

    Lung {sup 99m}Tc DTPA transfer was measured in HIV antibodypositive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP)). Lung {sup 99m}Tc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compred to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung basis in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of {sup 99m}Tc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs. (au).

  18. The effect of the jaw-thrust manoeuvre on the ability to advance a tracheal tube over a bronchoscope during oral fibreoptic intubation.

    Science.gov (United States)

    Han, S H; Oh, A Y; Jung, C W; Park, S J; Kim, J H; Nahm, F S

    2013-05-01

    During fibreoptic intubation, it is often difficult to advance a tracheal tube over the fibreoptic bronchoscope. We performed a prospective randomised study to investigate the effect of the jaw-thrust manoeuvre on the ability to advance a tracheal tube during oral fibreoptic intubation. After placing the bronchoscope in the trachea, an assistant randomly applied a jaw-thrust manoeuvre (jaw-thrust group) or sham manoeuvre (control group) in 82 patients during tube advancement. The jaw-thrust group had a higher success rate on the first attempt (70.7% vs 34.1%, p = 0.002), required fewer attempts (median (IQR [range]) 1 (1-2 [1-3]) vs 2 (1-3 [1-4]), p thrust manoeuvre facilitates the advancement of a tracheal tube over the bronchoscope during oral fibreoptic intubation. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  19. A comparison of halothane and sevoflurane for bronchoscopic removal of foreign bodies in children.

    Directory of Open Access Journals (Sweden)

    Batra Yatindra

    2004-01-01

    Full Text Available The present study was designed to compare induction and recovery characteristics of sevoflurane and halothane for rigid bronchoscopy for removal of foreign bodies in tracheobronchial tree in children. Forty four children (age 1-4 years were allocated randomly to two groups to receive either halothane (group H; n=22 or sevoflurane (group S; n=22 in oxygen. A graded inhalation technique was used with maximum inspiratory concentration of 5% for halothane and 8% for sevoflurane. Time for loss of consciousness and induction time in group H and group S were 2.3+/-0.4 min vs 2.2+/-0.4 min (p>0.05 and 4.6+/-0.7 min vs 4.9+/-0.6 min (p>0.05 respectively. Intubation conditions with rigid bronchoscope were similar in both groups. Fewer children in group H had vocal cord movements as compared to group S on laryngoscopy (3 vs 8, p>0.05. Six children in group H and two children in group S had disturbances of cardiac rhythm (p>0.05. Emergence time was significantly shorter in group S as compared to group H (group H - 29.6+/-10.7 min vs group S- 12.3+/-7.6 min, p<0.05. Modified Aldrete′s score of 8 was achieved significantly faster in group S as compared to group H (group H - 33.8+/-9.3 min vs group S- 17.3+/-6.8 min, p<0.05. Adverse events during induction and recovery were comparable between the two groups except for significantly high incidence of excitement in group S. In conclusion, halothane is as suitable as sevoflurane for children undergoing rigid bronchoscopy for airway foreign body retrieval, but sevoflurane has a quicker recovery.

  20. SU-C-BRE-02: BED Vs. Local Control: Radiobiological Effect of Tumor Volume in Monte Carlo (MC) Lung SBRT Planning

    Energy Technology Data Exchange (ETDEWEB)

    Pokhrel, D; Badkul, R; Jiang, H; Estes, C; Park, J; Kumar, P; Wang, F [UniversityKansas Medical Center, Kansas City, KS (United States)

    2014-06-15

    Purpose: SBRT with hypofractionated dose schemata has emerged a compelling treatment modality for medically inoperable early stage lung cancer patients. It requires more accurate dose calculation and treatment delivery technique. This report presents the relationship between tumor control probability(TCP) and size-adjusted biological effective dose(sBED) of tumor volume for MC lung SBRT patients. Methods: Fifteen patients who were treated with MC-based lung SBRT to 50Gy in 5 fractions to PTVV100%=95% were studied. ITVs were delineated on MIP images of 4DCT-scans. PTVs diameter(ITV+5mm margins) ranged from 2.7–4.9cm (mean 3.7cm). Plans were generated using non-coplanar conformal arcs/beams using iPlan XVMC algorithm (BrainLABiPlan ver.4.1.2) for Novalis-TX with HD-MLCs and 6MVSRS(1000MU/min) mode, following RTOG-0813 dosimetric guidelines. To understand the known uncertainties of conventional heterogeneities-corrected/uncorrected pencil beam (PBhete/ PB-homo) algorithms, dose distributions were re-calculated with PBhete/ PB-homo using same beam configurations, MLCs and monitor units. Biologically effective dose(BED10) was computed using LQ-model with α/β=10Gy for meanPTV and meanITV. BED10-c*L, gave size-adjusted BED(sBED), where c=10Gy/cm and L=PTV diameter in centimeter. The TCP model was adopted from Ohri et al.(IJROBP, 2012): TCP = exp[sBEDTCD50]/ k /(1.0 + exp[sBED-TCD50]/k), where k=31Gy corresponding to TCD50=0Gy; and more realistic MC-based TCP was computed for PTV(V99%). Results: Mean PTV PB-hete TCP value was 6% higher, but, mean PTV PB-homo TCP value was 4% lower compared to mean PTV MC TCP. Mean ITV PB-hete/PB-homo TCP values were comparable (within ±3.0%) to mean ITV MC TCP. The mean PTV(V99%)had BED10=90.9±3.7%(median=92.2%),sBED=54.1±8.2%(median=53.5%) corresponding to mean MC TCP value of 84.8±3.3%(median=84.9%) at 2- year local control. Conclusion: The TCP model which incorporates BED10 and tumor diameter indicates that radiobiological

  1. [Segmental bronchoalveolar lavage with a flexible probe via a rigid bronchoscope in the diagnosis of mediastino-pulmonary sarcoidosis].

    Science.gov (United States)

    Faina, A G

    1989-01-01

    Segmentary bronchial-alveolar lavage with flexible catheter connected to rigid bronchoscope might be used in diagnosis of mediastinal-pulmonary sarcoidosis, according to a method used by the authors. Cytologic examination of the lavage fluid shows, in the cases studied, the great abundance in cells, with lymphocytes increase to 30 +/- 12% (in agreement with other authors) making thus possible the disease diagnosis. On the other hand, polymorphonuclears increased to 20 +/- 10%. These higher values than those noticed up to now, pointed that the fibrosing process in sarcoidosis has a higher level than assumed, and appear since the onset of the disease.

  2. SU-E-T-289: Dose-Volume-Effect Relationships for Lung Cancer Patients Treated with SBRT On a Prospective Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Mayyas, E; Brown, S; Liu, J; Kim, J; Sun, Z; Devpura, S; Ajlouni, M; Siddiqui, F; Movsas, B; Chetty, I [Henry Ford Hospital, Detroit, MI (United States)

    2015-06-15

    Purpose: Stereotactic body radiotherapy (SBRT) is commonly used to treat early stage lung tumors. This study was designed to evaluate associations between dose, volume and clinical outcomes including analysis of both clinical toxicity scores and quality of life (QOL) data for non-small cell lung cancer patients treated with SBRT. Preliminary results are presented. Methods: Sixty-seven NSCLC patients, 46 primarily with early stage, and 21 with recurrent disease were treated with dose regimens consisting mainly of 12 Gy x 4 fractions, and 3 or 5 fractions at lower dose, for patients with recurrent disease (Table 1). Follow-up data is being collected at baseline, after treatment and at 3, 6, 12, 18 and 24 months post-treatment. Clinical follow-up data acquired to date was assessed using the Charlson Comorbidity Clinical and Toxicity Scoring forms. QOL data was evaluated using the EQ-5D, and FACT-TOI validated surveys. All outcomes surveys are collected within an “in-house” developed outcomes database. Results: The median follow-up was 3.5±0.8 months. Mean lung doses (MLD) were converted to BED-2 Gy using the linear-quadratic model with an alpha/beta=3.0. Average MLD was 3.7+3.1 Gy (range: 0.4–20.9 Gy). The percentages of patients with > grade 2 cough, dyspnea and fatigue were 13.3, 17.0, 6.3%, respectively. Preliminary analyses (at 3 months after SBRT) show a mild correlation between MLD > 2 Gy and > grade 2 cough (borderline significant) and dyspnea (significant, p<0.05). One patient was observed with a grade 3 cough. Given the short follow-up, tumor control is not yet assessable. Conclusion: The SBRT dose fractionation regimen of 12 Gy x 4 was well tolerated at early time points. Additional follow-up is required to assess the long-term clinical outcome efficacy and toxicity profiles of the dose regimen.

  3. Differential expression and prognostic significance of GLUT1 according to histologic type of non-small-cell lung cancer and its association with volume-dependent parameters.

    Science.gov (United States)

    Koh, Young Wha; Lee, Su Jin; Park, Seong Yong

    2017-02-01

    We evaluated glucose transporter type 1 (GLUT1) and carbonic anhydrase IX (CAIX) expression, together with volume-based(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters, in non-small cell lung cancer (NSCLC) patients, and examined the prognostic significance of those parameters according to its histologic subtype. A total of 269 patients, who underwent surgical resection for NSCLC, were reviewed retrospectively. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values were measured by preoperative (18)F-fluorodeoxyglucose positron emission tomography computed tomography. GLUT1 and CAIX expression was evaluated using immunohistochemical method. The mean MTV and TLG values were 30.0±57.1 and 165.4±361.3, respectively, and were significantly higher in patients with squamous cell carcinoma than with adenocarcinoma (p=0.047 for MTV; p=0.042 for TLG). GLUT1 expression was identified in 99% of squamous cell carcinoma and 50% of adenocarcinoma patients. MTV and TLG values were significantly higher in GLUT1-positive than GLUT-negative adenocarcinomas; however, CAIX expression did not show this pattern. GLUT1-positive adenocarcinoma patients had a lower OS than GLUT1-negative patients (p<0.001), whereas CAIX-positive and CAIX-negative patients showed similar OS rates (p=0.226). Patients with high MTV and TLG values showed lower OS rates than those with low MTV and TLG values. Multivariate analysis showed that GLUT1 positivity was an independent risk factor for a lower OS rate in lung adenocarcinoma patients (hazard ratio=2.574, p=0.016). GLUT1 expression was associated with micropapillary/solid histology, lymphovascular invasion, and advanced pTNM stage. MTV and TLG values, and GLUT1 expression, significantly differed between patients with squamous cell carcinoma and adenocarcinoma. High GLUT1 expression levels were significantly associated with MTV and TLG values and adverse clinical outcomes in patients with adenocarcinoma. Copyright

  4. Lung metastases

    Science.gov (United States)

    Metastases to the lung; Metastatic cancer to the lung; Lung cancer - metastases ... Metastatic tumors in the lungs are cancers that developed at other places in the body (or other parts of the lungs). They then spread through ...

  5. Correlation between [{sup 18}F]FDG PET/CT and volume perfusion CT in primary tumours and mediastinal lymph nodes of non-small-cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sauter, Alexander W.; Spira, Daniel; Schulze, Maximilian; Pfannenberg, Christina; Claussen, Claus D.; Horger, Marius S. [Eberhard Karls University, Diagnostic and Interventional Radiology, Department of Radiology, Tuebingen (Germany); Hetzel, Juergen [Eberhard Karls University, Department of Oncology, Hematology, Immunology, Rheumatology and Pulmonology, Tuebingen (Germany); Reimold, Matthias [Eberhard Karls University, Nuclear Medicine, Department of Radiology, Tuebingen (Germany); Klotz, Ernst [Siemens Healthcare, Computed Tomography, Forchheim (Germany)

    2013-05-15

    The aim of this study was to investigate correlations between glucose metabolism as determined by [{sup 18}F]FDG PET/CT and tumour perfusion as quantified by volume perfusion CT in primary tumours and mediastinal lymph nodes (MLN) of patients with non-small-cell lung cancer (NSCLC). Enrolled in the study were 17 patients with NSCLC. [{sup 18}F]FDG uptake was quantified in terms of SUV{sub max} and SUV{sub avg}. Blood flow (BF), blood volume (BV) and flow extraction product (K{sup trans}) were determined as perfusion parameters. The correlations between the perfusion parameters and [{sup 18}F]FDG uptake values were subsequently evaluated. For the primary tumours, no correlations were found between perfusion parameters and [{sup 18}F]FDG uptake. In MLN, there were negative correlations between BF and SUV{sub avg} (r = -0.383), BV and SUV{sub avg} (r = -0.406), and BV and SUV{sub max} (r = -0.377), but not between BF and SUV{sub max}, K{sup trans} and SUV{sub avg}, or K{sup trans} and SUV{sub max}. Additionally, in MLN with SUV{sub max} >2.5 there were negative correlations between BF and SUV{sub avg} (r = -0.510), BV and SUV{sub avg} (r = -0.390), BF and SUV{sub max} (r = -0.536), as well as BV and SUV{sub max} (r = -0.346). Perfusion and glucose metabolism seemed to be uncoupled in large primary tumours, but an inverse correlation was observed in MLN. This information may help improve therapy planning and response evaluation. (orig.)

  6. Increased interleukin-8 in epithelial lining fluid of collapsed lungs during one-lung ventilation for thoracotomy.

    Science.gov (United States)

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu

    2012-12-01

    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30 min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.

  7. Protolichesterinic acid, isolated from the lichen Cetraria islandica, reduces LRRC8A expression and volume-sensitive release of organic osmolytes in human lung epithelial cancer cells

    DEFF Research Database (Denmark)

    Thorsteinsdottir, Unnur Arna; Thorsteinsdottir, Margret; Lambert, Ian Henry

    2016-01-01

    We have tested the effect of protolichesterinic acid (PA) on the activity of the volume-sensitive release pathway for the organic osmolyte taurine (VSOAC) and the expression of the leucine-rich-repeat-channel 8A (LRRC8A) protein, which constitutes an essential VSOAC component. Exposing human lung...... of apoptosis) and p21 (regulator of cell cycle progression), respectively. PA reduces cell viability by 30% but has no effect on p21/Bax expression. This excludes PA as a pro-apoptotic drug in A549 cells....... cancer cells (A549) to PA (20 μg/mL, 24 h) reduces LRRC8A protein expression by 25% and taurine release following osmotic cell swelling (320 → 200 mOsm) by 60%. C75 (20 μg/mL, 24 h), a γ-lactone with a C8 carbon fatty acid chain, reduces VSOAC activity by 30%, i.e. less than PA. Stearic acid (20 μg......, excluding that PA mediated inhibition of VSOAC involves 5-LO inhibition. A549 cells exposed to the chemotherapeutic drug cisplatin (10 μM, 24 h) reveal signs of apoptosis, i.e. 25% reduction in cell viability as well as 1.3-, 1.5- and 3.3-fold increase in the expression of LRRC8A, Bax (regulator...

  8. Combined measurement of fetal lung volume and pulmonary artery resistance index is more accurate for prediction of neonatal respiratory distress syndrome in preterm fetuses: A Pilot Study.

    Science.gov (United States)

    Laban, Mohamed; Mansour, Ghada; El-Kotb, Ahmed; Hassanin, Alaa; Laban, Zina; Saleh, Abdelrahman

    2017-10-02

    To estimate optimal cut-off values for mean fetal lung volume (FLV) and pulmonary artery resistance index (PA-RI) as noninvasive measures to predict neonatal respiratory distress syndrome (RDS) in preterm fetuses. A prospective study conducted at Ain Shams University Maternity Hospital, Egypt from May 2015 to July 2017: eighty eligible women diagnosed with preterm labor were recruited at 32-36 weeks' gestation. Before delivery, three-dimensional ultrasound was used to estimate FLV using virtual organ computer-aided analysis (VOCAL), while PA-RI was measured by Doppler ultrasonography. A total of 80 women were examined. 37 (46%) of the newborns developed neonatal RDS. FLV was significantly lower in neonates who developed RDS (p = 0.04), whereas PARI was significantly higher in those who didn't (p = 0.02). Cut-off values of FLV ≤ 27.2 cm(3) and PARI ≥ 0.77 predicted the subsequent development of RDS. Combining both cut-offs generated a more sensitive and specific methodical approach for the prediction of RDS (sensitivity 100%, specificity 88.5%). Measurement of FLV or PA-RI can predict RDS in preterm fetuses. Combined use of both measures bolstered their predictive significance.

  9. Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease.

    Directory of Open Access Journals (Sweden)

    Hyun-ju Lim

    Full Text Available Surgical or bronchoscopic lung volume reduction (BLVR techniques can be beneficial for heterogeneous emphysema. Post-processing software tools for lobar emphysema quantification are useful for patient and target lobe selection, treatment planning and post-interventional follow-up. We aimed to evaluate the inter-software variability of emphysema quantification using fully automated lobar segmentation prototypes.66 patients with moderate to severe COPD who underwent CT for planning of BLVR were included. Emphysema quantification was performed using 2 modified versions of in-house software (without and with prototype advanced lung vessel segmentation; programs 1 [YACTA v.2.3.0.2] and 2 [YACTA v.2.4.3.1], as well as 1 commercial program 3 [Pulmo3D VA30A_HF2] and 1 pre-commercial prototype 4 [CT COPD ISP ver7.0]. The following parameters were computed for each segmented anatomical lung lobe and the whole lung: lobar volume (LV, mean lobar density (MLD, 15th percentile of lobar density (15th, emphysema volume (EV and emphysema index (EI. Bland-Altman analysis (limits of agreement, LoA and linear random effects models were used for comparison between the software.Segmentation using programs 1, 3 and 4 was unsuccessful in 1 (1%, 7 (10% and 5 (7% patients, respectively. Program 2 could analyze all datasets. The 53 patients with successful segmentation by all 4 programs were included for further analysis. For LV, program 1 and 4 showed the largest mean difference of 72 ml and the widest LoA of [-356, 499 ml] (p<0.05. Program 3 and 4 showed the largest mean difference of 4% and the widest LoA of [-7, 14%] for EI (p<0.001.Only a single software program was able to successfully analyze all scheduled data-sets. Although mean bias of LV and EV were relatively low in lobar quantification, ranges of disagreement were substantial in both of them. For longitudinal emphysema monitoring, not only scanning protocol but also quantification software needs to be kept

  10. Regional tidal lung strain in mechanically ventilated normal lungs.

    Science.gov (United States)

    Paula, Luis Felipe; Wellman, Tyler J; Winkler, Tilo; Spieth, Peter M; Güldner, Andreas; Venegas, Jose G; Gama de Abreu, Marcelo; Carvalho, Alysson R; Vidal Melo, Marcos F

    2016-12-01

    Parenchymal strain is a key determinant of lung injury produced by mechanical ventilation. However, imaging estimates of volumetric tidal strain (ε = regional tidal volume/reference volume) present substantial conceptual differences in reference volume computation and consideration of tidally recruited lung. We compared current and new methods to estimate tidal volumetric strains with computed tomography, and quantified the effect of tidal volume (VT) and positive end-expiratory pressure (PEEP) on strain estimates. Eight supine pigs were ventilated with VT = 6 and 12 ml/kg and PEEP = 0, 6, and 12 cmH2O. End-expiratory and end-inspiratory scans were analyzed in eight regions of interest along the ventral-dorsal axis. Regional reference volumes were computed at end-expiration (with/without correction of regional VT for intratidal recruitment) and at resting lung volume (PEEP = 0) corrected for intratidal and PEEP-derived recruitment. All strain estimates demonstrated vertical heterogeneity with the largest tidal strains in middependent regions (P < 0.01). Maximal strains for distinct estimates occurred at different lung regions and were differently affected by VT-PEEP conditions. Values consistent with lung injury and inflammation were reached regionally, even when global measurements were below critical levels. Strains increased with VT and were larger in middependent than in nondependent lung regions. PEEP reduced tidal-strain estimates referenced to end-expiratory lung volumes, although it did not affect strains referenced to resting lung volume. These estimates of tidal strains in normal lungs point to middependent lung regions as those at risk for ventilator-induced lung injury. The different conditions and topography at which maximal strain estimates occur allow for testing the importance of each estimate for lung injury.

  11. Comparison of endotracheal aspirate and non-bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia in a pediatric intensive care unit.

    Science.gov (United States)

    Yıldız-Atıkan, Başak; Karapınar, Bülent; Aydemir, Şöhret; Vardar, Fadıl

    2015-01-01

    Ventilator-associated pneumonia (VAP) is defined as pneumonia occuring in any period of mechanical ventilation. There is no optimal diagnostic method in current use and in this study we aimed to compare two non-invasive diagnostic methods used in diagnosis of VAP in children. This prospective study was conducted in 8 bedded Pediatric Intensive Care Unit at Ege University Children´s Hospital. Endotracheal aspiration (ETA) and non-bronchoscopic bronchoalveolar lavage (BAL) were performed in case of developing VIP after 48 hours of ventilation. Quantitative cultures were examined in Ege University Department of Diagnostic Microbiology, Bacteriology Laboratory. Fourty-one patients were enrolled in the study. The mean age of study subjects was 47.2±53.6 months. A total of 28 in 82 specimens taken with both methods were negative/negative; 28 had positive result with ETA and a negative result with non-bronchoscopic BAL and both results were negative in 26 specimens. There were no patients whose respiratory specimen culture was negative with ETA and positive with non-bronchoscopic BAL. These results imply that there is a significant difference between two diagnostic methods (p ETA results were compared with this method. ETA's sensitivity, specificity, negative and positive predictive values were 100%, 50%, 100% and 48% respectively. The study revealed the ease of usability and the sensitivity of non-bronchoscopic BAL, in comparison with ETA.

  12. Microgravity and the lung

    Science.gov (United States)

    West, John B.

    1991-01-01

    Results are presented from studies of the effect of microgravity on the lungs of rats flown on the Cosmos 2044 mission, and from relevant laboratory experiments. The effects of microgravity fall into five categories: topographical structure and function, the lung volumes and mechanics, the intrathoracic blood pressures and volumes, the pulmonary deposition of aerosol, and denitrogenaton during EVA. The ultrastructure of the left lungs of rats flown for 14 days on the Cosmos 2044 spacecraft and that of some tail-suspended rats disclosed presence of red blood cells in the alveolar spaces, indicating that pulmonary hemorrhage and pulmonary edema occurred in these rats. Possible causes for this phenomenon are discussed.

  13. 三维超声在隔疝胎儿肺容积测量中的应用%3D sonographic measurement of lung volume in fetuses with congenital diaphragmatic hernia

    Institute of Scientific and Technical Information of China (English)

    张波; 杨太珠

    2011-01-01

    目的:评价三维超声测量先天性膈疝(Congenital diaphragmatic hernia,CDH)胎儿肺容积的准确性,并初步探讨CDH胎儿肺容积改变规律.方法:对10例拟引产的CDH胎儿于引产前1-3d应用三维超声体积自动测量技术(Virtual organ computer-aided analysis,VOCAL)测得其肺容积值,引产后6h内对胎儿进行病检,用水置换法得到其实际容积.同时测量150例正常对照组胎儿肺容积.并与CDH胎儿进行统计学比较.结果:①三维超声测量CDH胎儿肺容积与病检结果间有较好的相关性,相关系数(r)为0.79,偏倚及95%一致性界限分别为0.68cm3及(-4.59-3.24)cm';②CDH胎儿肺容积较同孕周对照组明显减小.结论:先天性隔疝时胎儿肺脏受压体积明显缩小;三维超声测量CDH胎儿肺容积的准确性较好,可能成为评估其肺发育不良程度的重要方法.%Objective: To evaluate the accuracy of 3D ultrasound in estimating lung volume of fetuses with congenital diaphragmatic hernia (CDH), and to determine their volume change by comparing with the normal fetuses.Methods: Fetal lung volumes were measured during 3D ultrasound examination using VOCAL technique in 10 cases with CDH, 1~3 days before termination.Postmortem autopsy was conducted within 6 hours after labor and the lung volume was achieved by water displacement.Using VOCAL technique, lung volumes were also measured in controls and compared with those in CDHs.Results: ①The correlation between measured volume by 3D ultrasound and postmortem examination was good, with correlation coefficient 0.79 in CDH fetuses.The mean bias, 95% limits of agreement were, -0.68cm3 and (-4.59~3.24)cm3, respectively.②In fetuses with CDH, lung volumes were substantially lower than in normal fetuses.Conclusion: The lung volumes were significantly reduced in CDH fetuses, due to pulmonary compression.Prenatal 3D ultrasound can estimate accurately fetal lung volumes in CDHs, which may become a potential predictor

  14. The lung cancer breath signature: a comparative analysis of exhaled breath and air sampled from inside the lungs

    Science.gov (United States)

    Capuano, Rosamaria; Santonico, Marco; Pennazza, Giorgio; Ghezzi, Silvia; Martinelli, Eugenio; Roscioni, Claudio; Lucantoni, Gabriele; Galluccio, Giovanni; Paolesse, Roberto; di Natale, Corrado; D'Amico, Arnaldo

    2015-11-01

    Results collected in more than 20 years of studies suggest a relationship between the volatile organic compounds exhaled in breath and lung cancer. However, the origin of these compounds is still not completely elucidated. In spite of the simplistic vision that cancerous tissues in lungs directly emit the volatile metabolites into the airways, some papers point out that metabolites are collected by the blood and then exchanged at the air-blood interface in the lung. To shed light on this subject we performed an experiment collecting both the breath and the air inside both the lungs with a modified bronchoscopic probe. The samples were measured with a gas chromatography-mass spectrometer (GC-MS) and an electronic nose. We found that the diagnostic capability of the electronic nose does not depend on the presence of cancer in the sampled lung, reaching in both cases an above 90% correct classification rate between cancer and non-cancer samples. On the other hand, multivariate analysis of GC-MS achieved a correct classification rate between the two lungs of only 76%. GC-MS analysis of breath and air sampled from the lungs demonstrates a substantial preservation of the VOCs pattern from inside the lung to the exhaled breath.

  15. Large Cell Neuroendocrine Carcinoma of the Lung

    Directory of Open Access Journals (Sweden)

    Yusuf Aydemir

    2015-11-01

    Full Text Available Large-cell neuroendocrine carcinomas of the lung are extremely rare. There are difficulties related to the diagnosis and treatment and there are no consensus because of the small number of studies. 65-year-old male patient presented with hemoptysis. Chest X-ray and thoracic computorized tomography scan showed a mass lesion and it could not be diagnosed by bronchoscopic biopsy and lavage. Lobectomy was performed due to the high value of standardized uptake value in positron emission tomography. Large cell neuroendocrine carcinoma was diagnosed with pathological evaluation and immunohistochemical study and after 20-month follow-up there was no recurrence. The diagnosis, treatment, and prognosis of large cell neuroendocrine carcinoma in the light of the literature is presented.

  16. An approach towards bronchoscopic-based gene therapy using electrical field accelerated plasmid droplets.

    Science.gov (United States)

    Hradetzky, D; Boehringer, S; Geiser, Th; Gazdhar, A

    2012-01-01

    Idiopathic pulmonary fibrosis (IPF) is a devastating disease affecting the distal lung, due to failure of the alveolar epithelium to heal after micro-injuries, leading to inefficient gas exchange and resulting in death. Therapeutic options are very limited. A new therapeutic approach based on gene therapy restores the self-healing process within the lung in the experimental setup. A basic requirement of this therapy is the successful transduction of genes into the alveolar epithelium in the distal part of the lung, for which a new therapeutic instrument is required. In this paper we present the concept and first experimental results of a device which uses an electrical field to accelerate the charged droplets of plasmid suspension toward the tissue and which overcomes cell membrane with its impact energy. The aim is to develop a therapeutic device capable of being integrated into minimally invasive procedures such as bronchoscopy.

  17. [Significance of extravascular lung water index, pulmonary vascular permeability index, and in- trathoracic blood volume index in the differential diagnosis of burn-induced pulmonary edema].

    Science.gov (United States)

    Lei, Li; Jiajun, Sheng; Guangyi, Wang; Kaiyang, Lyu; Jing, Qin; Gongcheng, Liu; Bing, Ma; Shichu, Xiao; Shihui, Zhu

    2015-06-01

    To appraise the significance of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and intrathoracic blood volume index (ITBVI) in the differential diagnosis of the type of burn-induced pulmonary edema. The clinical data of 38 patients, with severe burn hospitalized in our burn ICU from December 2011 to September 2014 suffering from the complication of pulmonary edema within one week post burn and treated with mechanical ventilation accompanied by pulse contour cardiac output monitoring, were retrospectively analyzed. The patients were divided into lung injury group ( L, n = 17) and hydrostatic group (H, n = 21) according to the diagnosis of pulmonary edema. EVLWI, PVPI, ITBVI, oxygenation index, and lung injury score ( LIS) were compared between two groups, and the correlations among the former four indexes and the correlations between each of the former three indexes and types of pulmonary edema were analyzed. Data were processed with t test, chi-square test, Mann-Whitney U test, Pearson correlation test, and accuracy test [receiver operating characteristic (ROC) curve]. There was no statistically significant difference in EVLWI between group L and group H, respectively (12.9 ± 3.1) and (12.1 ± 2.1) mL/kg, U = 159.5, P > 0.05. The PVPI and LIS of patients in group L were respectively 2.6 ± 0.5 and (2.1 ± 0.6) points, and they were significantly higher than those in group H [1.4 ± 0.3 and (1.0 ± 0.6) points, with U values respectively 4.5 and 36.5, P values below 0.01]. The ITBVI and oxygenation index of patients in group L were respectively (911 197) mL/m2 and (136 ± 69) mmHg (1 mmHg = 0.133 kPa), which were significantly lower than those in group H [(1,305 ± 168) mL/m2 and (212 ± 60) mmHg, with U values respectively 21.5 and 70.5, P values below 0.01]. In group L, there was obviously positive correlation between EVLWI and PVPI, or EVLWI and ITBVI (with r values respectively 0.553 and 0.807, P < 0.05 or P < 0.01), and

  18. Whole-body metabolic tumour volume of {sup 18}F-FDG PET/CT improves the prediction of prognosis in small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jong-Ryool; Chong, Ari; Min, Jung-Joon; Song, Ho-Chun; Bom, Hee-Seung [Chonnam National University Medical School and Hospital, Department of Nuclear Medicine, Gwangju (Korea, Republic of); Seo, Ji-Hyoung [Daegu Fatima Hospital, Department of Nuclear Medicine, Daegu (Korea, Republic of); Kim, Young-Chul [Chonnam National University Hwasun Hospital, Department of Internal Medicine, Hwasun-gun (Korea, Republic of)

    2012-06-15

    We investigated whether the whole-body metabolic tumour volume (WBMTV) measured by {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can improve the prediction of prognosis in patients with small cell lung cancer (SCLC). We reviewed 106 consecutive patients (mean age 67 years, range 42-89 years, limited stage 45 patients, extensive stage 61 patients) with pathologically proven SCLC who underwent pretreatment FDG PET/CT. WBMTV and maximum standardized uptake value (SUV{sub max}) were measured in all malignant lesions. The Cox proportional hazards model was used with age, sex, performance status, lactate dehydrogenase (LDH), treatment, stage, SUV{sub max} and WBMTV to predict overall survival (OS) and progression-free survival (PFS). Subgroup analysis was performed using WBMTV combined with conventional staging and tumour node metastasis (TNM) staging. The uni- and multivariate analyses showed that both stage and WBMTV were independent prognostic factors for death and progression. Patients with high WBMTV were associated with poor prognosis compared with patients with low WBMTV [hazard ratio = 2.11 (95% confidence interval 1.31-3.39) for death (p = 0.002) and 1.80 (95% confidence interval 1.16-2.80) for progression (p = 0.009)]. Incorporation of conventional staging and WBMTV could classify four subgroups with different prognoses (log-rank test, p < 0.001). Incorporation of TNM staging and WBMTV could classify six subgroups with different prognoses (log-rank test, p < 0.001). WBMTV is an independent predictor for progression and death in patients with SCLC. Incorporation of WBMTV with TNM staging can provide a more detailed prediction of prognosis than WBMTV with conventional staging as well as tumour staging alone. (orig.)

  19. Estimation of non-solid lung nodule volume with low-dose CT protocols: effect of reconstruction algorithm and measurement method

    Science.gov (United States)

    Gavrielides, Marios A.; DeFilippo, Gino; Berman, Benjamin P.; Li, Qin; Petrick, Nicholas; Schultz, Kurt; Siegelman, Jenifer

    2017-03-01

    Computed tomography is primarily the modality of choice to assess stability of nonsolid pulmonary nodules (sometimes referred to as ground-glass opacity) for three or more years, with change in size being the primary factor to monitor. Since volume extracted from CT is being examined as a quantitative biomarker of lung nodule size, it is important to examine factors affecting the performance of volumetric CT for this task. More specifically, the effect of reconstruction algorithms and measurement method in the context of low-dose CT protocols has been an under-examined area of research. In this phantom study we assessed volumetric CT with two different measurement methods (model-based and segmentation-based) for nodules with radiodensities of both nonsolid (-800HU and -630HU) and solid (-10HU) nodules, sizes of 5mm and 10mm, and two different shapes (spherical and spiculated). Imaging protocols included CTDIvol typical of screening (1.7mGy) and sub-screening (0.6mGy) scans and different types of reconstruction algorithms across three scanners. Results showed that radio-density was the factor contributing most to overall error based on ANOVA. The choice of reconstruction algorithm or measurement method did not affect substantially the accuracy of measurements; however, measurement method affected repeatability with repeatability coefficients ranging from around 3-5% for the model-based estimator to around 20-30% across reconstruction algorithms for the segmentation-based method. The findings of the study can be valuable toward developing standardized protocols and performance claims for nonsolid nodules.

  20. Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

    Energy Technology Data Exchange (ETDEWEB)

    Hagelstein, Claudia; Weidner, Meike; Schoenberg, Stefan O.; Buesing, Karen A.; Neff, K.W. [University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim (Germany); Zahn, Katrin [University of Heidelberg, Department of Pediatric Surgery, University Medical Center Mannheim, Mannheim (Germany); Weiss, Christel [University of Heidelberg, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Mannheim (Germany); Schaible, Thomas [University of Heidelberg, Department of Pediatrics, University Medical Center Mannheim, Mannheim (Germany)

    2015-01-15

    To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV). The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair. Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827). Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy. (orig.)

  1. Probability of mediastinal involvement in non-small-cell lung cancer: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy?

    Science.gov (United States)

    Giraud, Philippe; De Rycke, Yann; Lavole, Armelle; Milleron, Bernard; Cosset, Jean-Marc; Rosenzweig, Kenneth E

    2006-01-01

    Conformal irradiation (3D-CRT) of non-small-cell lung carcinoma (NSCLC) is largely based on precise definition of the nodal clinical target volume (CTVn). A reduction of the number of nodal stations to be irradiated would facilitate tumor dose escalation. The aim of this study was to design a mathematical tool based on documented data to predict the risk of metastatic involvement for each nodal station. We reviewed the large surgical series published in the literature to identify the main pretreatment parameters that modify the risk of nodal invasion. The probability of involvement for the 17 nodal stations described by the American Thoracic Society (ATS) was computed from all these publications. Starting with the primary site of the tumor as the main characteristic, we built a probabilistic tree for each nodal station representing the risk distribution as a function of each tumor feature. Statistical analysis used the inversion of probability trees method described by Weinstein and Feinberg. Validation of the software based on 134 patients from two different populations was performed by receiver operator characteristic (ROC) curves and multivariate logistic regression. Analysis of all of the various parameters of pretreatment staging relative to each level of the ATS map results in 20,000 different combinations. The first parameters included in the tree, depending on tumor site, were histologic classification, metastatic stage, nodal stage weighted as a function of the sensitivity and specificity of the diagnostic examination used (positron emission tomography scan, computed tomography scan), and tumor stage. Software is proposed to compute a predicted probability of involvement of each nodal station for any given clinical presentation. Double cross validation confirmed the methodology. A 10% cutoff point was calculated from ROC and logistic model giving the best prediction of mediastinal lymph node involvement. To more accurately define the CTVn in NSCLC three

  2. Lung Emergencies

    Science.gov (United States)

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at ... should be considered an emergency. Symptoms of sudden lung collapse (pneumothorax) Symptoms of a sudden lung collapse ...

  3. 液基细胞制片术在纤维支气管镜抽吸物检测中的应用%Application of liquid based cytology test in detection of fiber bronchoscopic aspirates

    Institute of Scientific and Technical Information of China (English)

    万涛; 黄习臣; 粟毅; 李岱容

    2014-01-01

    Objective To study liquid based cytology test and its application values in the detection of fiber bronchoscopic aspi‐rates .Methods LBP sedimentation type of ThinPrep cell production system combined with the conventional smear were used to de‐tect 2000 specimens of fiber bronchoscopic aspirates ,and conduct microscope observation and cytological diagnosis .Results Based on liquid based cytology cell production method ,there were 614 positive cases (30 .7% ) ,267 cases of squamous cell carcinoma (13 .4% ) ,and 217 cases of adenocarcinoma(10 .9% ) ,83 cases of small cell carcinoma (4 .2% ) ,and 47 cases of undifferentiated car‐cinoma (2 .4% ) .The diagnostic sensitivity for lung cancer of liquid‐based cytology test was 64 .6% and conventional smear was 49 .2% .We also found 7 cases of fungus positive ,35 cases of typical caseous necrosis with liquid based cytology test .Conclusion The ThinPrep cell production has a more clean background ,more intact cell structure ,more efficient observation and increased posi‐tive rate of detection of cancer cells than the smears made by traditional methods .A combination of two methods can increase the accuracy of cytological detection of fiber bronchoscope aspirates and positive detection rate ,and also can assist the diagnosis of fungi and TB infections .%目的:探讨液基细胞制片技术在纤维支气管镜抽吸物检测中的应用价值。方法采用安必平(LBP)沉降式液基细胞制片系统并结合传统涂片方法处理纤维支气管镜抽吸标本2000例,制成薄片,显微镜下观察,进行细胞学诊断。结果液基细胞制片法共检出细胞学阳性病例614例(30.7%),其中鳞癌267例(13.4%),腺癌217例(10.9%),小细胞癌83例(4.2%),未定型癌47例(2.4%)。液基制片法诊断肺癌敏感度为64.6%,传统涂片法诊断肺癌敏感度为49.2%。同时发现真菌阳性7例,结核病典型的干酪样坏死35

  4. 经支气管镜介入冷冻治疗支气管结核的临床效果分析%Clinical study of bronchoscopic interventional cryotherapy in the treatment of 158 cases of ;bronchial tuberculosis

    Institute of Scientific and Technical Information of China (English)

    杜江渝; 赵懿

    2016-01-01

    Objective: This study aims to investigate the clinical effect of bronchoscopic interventional cryotherapy in the treatment of bronchial tuberculosis (BTB). Methods:158 patients admitted into our hospital from October 2012 to October 2015 were randomly divided into observation group (n=80) and control group (n=78). The control group was treated with standardized systemic chemotherapy, and the observation was treated by bronchoscopic interventional cryotherapy based on the control group in order to compare the negative rate of sputum bacteria, clinical efficacy and adverse reactions. Results: After treatment, the turn rate of the observation group was 98.75%, significantly higher than that of the control group (89.74%) (x2=5.964, P0.05). Conclusion:It has obvious clinical curative effect of bronchoscopic interventional cryotherapy in the treatment of BTB. With simple operation, it has a higher negative rate of sputum bacteria and lower incidence of adverse reactions. It also can effectively improve the pulmonary function and protect lung tissue, which is worth popularizing in clinical application.%目的:探讨经支气管镜介入冷冻治疗支气管结核(BTB)的临床疗效。方法:选取158例支气管结核患者,按照随机数表法将其分为观察组(80例)和对照组(78例)。两组均进行规范化全身化疗,而观察组在规范化全身化疗基础上联合支气管镜介入冷冻治疗。观察比较两组患者痰菌转阴率、临床疗效及不良反应发生情况。结果:治疗后观察组疾菌转阴率为98.75%,显著高于对照组的89.74%,两组相比有明显差异(x2=5.964,P<0.05);观察组临床有效率为97.50%,显著高于对照组的84.62%,两组相比有差异(x2=8.119,P<0.05);观察组不良反应发生4例(占5.00%),对照组10例(占12.82%),两组相比无差异(x2=2.236,P>0.05)。结论:经支气管镜介入冷冻治疗BTB临床疗效显著,痰菌转阴率高,不良反应发

  5. 电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理%Nursing of electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis

    Institute of Scientific and Technical Information of China (English)

    郑淑芳; 吴素芳; 黄钥藩

    2013-01-01

    Objective To explore nursing care of electronic bronchoscopic cryotherapy in the treatment of bronchial stenosis secondary to endobronchial tuberculosis.Methods The nursing experience on electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis was summarized.Mental nursing and respiratory care were strengthened,preoperative preparation was done well,respiratory nursing was carefully performed to improve patient compliance,intraoperative and postoperative adverse reactions were carefully observed,and complications were effectively prevented.Results All the patients received treatment.8 patients developed postoperative blood stained sputum and were finally cured without special treatment.A minority of 28 participants had feeling of scare and accepted treatment after counseling.Correct nursing care improved patient compliance and the success rate of surgery.Conclusions Electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis improve clinical symptoms and promote lung reexpansion.Effective perioperative nursing can improve patient compliance and success rate of surgery and reduce postoperative complications.%目的 探讨电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理.方法 总结28例电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理经验,重点加强心理护理和呼吸道护理,做好术前准备、注意术中不良反应、术后呼吸道护理,从而提高患者的依从性,有效预防并发症的发生.结果 本组所有患者均接受治疗,术后8例痰中带血丝,在未予特殊处理情况下均痊愈.所有参加研究的28例患者,有少数有畏惧心理,经过辅导均接受治疗,说明正确的护理,能提高患者的依从性及手术的成功率.结论 电子支气管镜冷冻治疗在治疗支气管内膜结核支气管狭窄、改善临床症状、促使肺组织复张上效果良好,通过术前、术

  6. A study to evaluate asbestos fiber burden in lung and pleural malignancies

    Directory of Open Access Journals (Sweden)

    S K Verma

    2010-01-01

    Full Text Available Background: There is scarcity of data on asbestos fiber burden in lung and pleural malignancies. Aim: To evaluate asbestos fiber burden in biopsy samples of suspected lung and pleural malignancies. Study Design: This was a single-centre, observational study. Study Period: From August 2010 to July 2010. Setting: Department of Pulmonary Medicine, CSMMU, UP, Lucknow, a tertiary care hospital in India. Study Population: Suspected cases of lung and pleural malignancy. Materials and Methods: Biopsy tissues taken by computed tomography (CT-guided biopsy, bronchoscopic biopsy, and pleural biopsy by Cope′s needle were analyzed for histopathology and asbestos burden by Haq et al.′s method. Results: 20 patients were studied. Mean fiber burden was 9.25 × 10 >4 fibers/g. Average burden in lung malignancies (11 patients was 9.178 × 10 >4 fibers/g and in pleural tissue (9 patients was 9.332 × 10 >4fibers/g. Among the different cell types, mean fiber burden in squamous cell carcinoma was 8.99 × 10 >4 fibers/g, in adenocarcinoma was 9.71 × 10 >4 fibers/g, and in small cell carcinoma was 7.54 × 10 >4 fibers/g. Mean fiber burden in bronchoscopic endobronchial biopsy tissue was 10.69 × 10 >4 fibers/g, while in CT-guided biopsy was 8.60× 10 >4fibers/g. Conclusion: Maximum number of fibers was found in adenocarcinoma.

  7. Effect of low tidal volume one lung ventilation plus positive end-expiratory pressure on inflammatory responses of pulmonary in patients with lung cancer operation%低潮气量单肺通气复合呼气末正压对肺癌手术患者肺部炎症反应的影响

    Institute of Scientific and Technical Information of China (English)

    孔岚

    2014-01-01

    Objective To compare the effect of low tidal volume and normal tidal volume one lung ventilation plus positive end-expiratory pressure(PEEP) on inflammatory responses of pulmonary in patients with lung cancer operation.Methods Divided 40 patients with lung cancer operation into PEEP group(group L) and normal tidal volume one lung ventilation group(goup N), 20 cases in each group, tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), Interleukin-8(IL-8) and Interleukin-10(IL-10) were assessed with ELISA on the following time①two lung ventilation after anesthesia induction(T1); ②60 min after one lung ventilation (T2); ③90 min after one lung ventilation (T3); ④60 min after two lung ventilation(T4); ⑤1d after operation (T5). Results Compared to T1, TNF-α、IL-6、IL-8 and IL-10 were increased in other time point in both groups. The TNF-α、IL-6、IL -8 in group L were significant decreased than group N in T2, T3, T4, T5 time point(P<0.05). The IL-10 in group L were significant increased than group N in T2, T3, T4, T5 time point(P<0.05).Conclusion Low tidal volume one lung ventilation plus positive end-expiratory pressure can lessen pulmonary inflammatory response obviously than normal tidal volume and relieve the lung injury.%目的:对比低潮气量单肺通气复合呼气末正压(PEEP)与正常潮气量单肺通气对肺癌手术患者肺部炎症反应的影响。方法40例择期肺癌手术患者随机分为低潮气量单肺通气复合PEEP组(L组)和正常潮气量单肺通气组(N组),每组20例。两组患者分别在麻醉诱导后双肺通气时(T1)、单肺通气60 min时(T2)、单肺通气90 min时(T3)、术毕双肺通气60 min时(T4)、术后1 d(T5)采取外周静脉血,采用放射酶联免疫吸附法(ELISA)测量肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及白细胞介素-10(IL-10)水平。结果与T1比较,两组各时点血浆TNF-α, IL-6, IL-8及IL-10水平均持续升高(P<0.05)

  8. Photodynamic therapy for the treatment of non-small cell lung cancer.

    Science.gov (United States)

    Simone, Charles B; Friedberg, Joseph S; Glatstein, Eli; Stevenson, James P; Sterman, Daniel H; Hahn, Stephen M; Cengel, Keith A

    2012-02-01

    Photodynamic therapy is increasingly being utilized to treat thoracic malignancies. For patients with early-stage non-small cell lung cancer, photodynamic therapy is primarily employed as an endobronchial therapy to definitely treat endobronchial, roentgenographically occult, or synchronous primary carcinomas. As definitive monotherapy, photodynamic therapy is most effective in treating bronchoscopically visible lung cancers ≤1 cm with no extracartilaginous invasion. For patients with advanced-stage non-small cell lung cancer, photodynamic therapy can be used to palliate obstructing endobronchial lesions, as a component of definitive multi-modality therapy, or to increase operability or reduce the extent of operation required. A review of the available medical literature detailing all published studies utilizing photodynamic therapy to treat at least 10 patients with non-small cell lung cancer is performed, and treatment recommendations and summaries for photodynamic therapy applications are described.

  9. A comparative study of the target volume definition in radiotherapy with «Slow CT Scan» vs. 4D PET/CT Scan in early stages non-small cell lung cancer.

    Science.gov (United States)

    Molla, M; Anducas, N; Simó, M; Seoane, A; Ramos, M; Cuberas-Borros, G; Beltran, M; Castell, J; Giralt, J

    To evaluate the use of 4D PET/CT to quantify tumor respiratory motion compared to the «Slow»-CT (CTs) in the radiotherapy planning process. A total of 25 patients with inoperable early stage non small cell lung cancer (NSCLC) were included in the study. Each patient was imaged with a CTs (4s/slice) and 4D PET/CT. The adequacy of each technique for respiratory motion capture was evaluated using the volume definition for each of the following: Internal target volume (ITV) 4D and ITVslow in relation with the volume defined by the encompassing volume of 4D PET/CT and CTs (ITVtotal). The maximum distance between the edges of the volume defined by each technique to that of the total volume was measured in orthogonal beam's eye view. The ITV4D showed less differences in relation with the ITVtotal in both the cranio-caudal and the antero-posterior axis compared to the ITVslow. The maximum differences were 0.36mm in 4D PET/CTand 0.57mm in CTs in the antero-posterior axis. 4D PET/CT resulted in the definition of more accurate (ITV4D/ITVtotal 0.78 vs. ITVs/ITVtotal 0.63), and larger ITVs (19.9 cc vs. 16.3 cc) than those obtained with CTs. Planning with 4D PET/CT in comparison with CTs, allows incorporating tumor respiratory motion and improving planning radiotherapy of patients in early stages of lung cancer. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  10. Colonic Metastasis From a Primary Adenocarcinoma of the Lung Presenting with Acute Abdominal Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Ming-Wei Weng

    2010-01-01

    Full Text Available Colonic metastasis from lung cancer is rare and generally asymptomatic. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain due to intestinal obstruction caused by the metastatic colon tumor. The patient underwent emergency colonoscopy and the pathologic report was adenocarcinoma, which was the same as that for a bronchoscopic biopsy from a large lung mass. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7, and negative for cytokeratin 20 and caudal-related homeobox transcription factor 2 on both lung biopsy and colon surgical specimens. Accordingly, we used immunohisto-chemistry for thyroid transcription factor-1, cytokeratin 7, cytokeratin 20 and caudal-related homeobox transcription factor-2 to diagnose primary adenocarcinoma of the lung with colonic metastasis.

  11. Reduction in Tumor Volume by Cone Beam Computed Tomography Predicts Overall Survival in Non-Small Cell Lung Cancer Treated With Chemoradiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jabbour, Salma K., E-mail: jabbousk@cinj.rutgers.edu [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Kim, Sinae [Division of Biometrics, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Department of Biostatistics, School of Public Health, Rutgers University, New Brunswick, New Jersey (United States); Haider, Syed A. [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Xu, Xiaoting [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow (China); Wu, Alson [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Surakanti, Sujani; Aisner, Joseph [Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Langenfeld, John [Division of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States); Yue, Ning J.; Haffty, Bruce G.; Zou, Wei [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, New Jersey (United States)

    2015-07-01

    Purpose: We sought to evaluate whether tumor response using cone beam computed tomography (CBCT) performed as part of the routine care during chemoradiation therapy (CRT) could forecast the outcome of unresectable, locally advanced, non-small cell lung cancer (NSCLC). Methods and Materials: We manually delineated primary tumor volumes (TV) of patients with NSCLC who were treated with radical CRT on days 1, 8, 15, 22, 29, 36, and 43 on CBCTs obtained as part of the standard radiation treatment course. Percentage reductions in TV were calculated and then correlated to survival and pattern of recurrence using Cox proportional hazard models. Clinical information including histologic subtype was also considered in the study of such associations. Results: We evaluated 38 patients with a median follow-up time of 23.4 months. The median TV reduction was 39.3% (range, 7.3%-69.3%) from day 1 (D1) to day 43 (D43) CBCTs. Overall survival was associated with TV reduction from D1 to D43 (hazard ratio [HR] 0.557, 95% CI 0.39-0.79, P=.0009). For every 10% decrease in TV from D1 to D43, the risk of death decreased by 44.3%. For patients whose TV decreased ≥39.3 or <39.3%, log-rank test demonstrated a separation in survival (P=.02), with median survivals of 31 months versus 10 months, respectively. Neither local recurrence (HR 0.791, 95% CI 0.51-1.23, P=.29), nor distant recurrence (HR 0.78, 95% CI 0.57-1.08, P=.137) correlated with TV decrease from D1 to D43. Histologic subtype showed no impact on our findings. Conclusions: TV reduction as determined by CBCT during CRT as part of routine care predicts post-CRT survival. Such knowledge may justify intensification of RT or application of additional therapies. Assessment of genomic characteristics of these tumors may permit a better understanding of behavior or prediction of therapeutic outcomes.

  12. Estimation of Lung Ventilation

    Science.gov (United States)

    Ding, Kai; Cao, Kunlin; Du, Kaifang; Amelon, Ryan; Christensen, Gary E.; Raghavan, Madhavan; Reinhardt, Joseph M.

    Since the primary function of the lung is gas exchange, ventilation can be interpreted as an index of lung function in addition to perfusion. Injury and disease processes can alter lung function on a global and/or a local level. MDCT can be used to acquire multiple static breath-hold CT images of the lung taken at different lung volumes, or with proper respiratory control, 4DCT images of the lung reconstructed at different respiratory phases. Image registration can be applied to this data to estimate a deformation field that transforms the lung from one volume configuration to the other. This deformation field can be analyzed to estimate local lung tissue expansion, calculate voxel-by-voxel intensity change, and make biomechanical measurements. The physiologic significance of the registration-based measures of respiratory function can be established by comparing to more conventional measurements, such as nuclear medicine or contrast wash-in/wash-out studies with CT or MR. An important emerging application of these methods is the detection of pulmonary function change in subjects undergoing radiation therapy (RT) for lung cancer. During RT, treatment is commonly limited to sub-therapeutic doses due to unintended toxicity to normal lung tissue. Measurement of pulmonary function may be useful as a planning tool during RT planning, may be useful for tracking the progression of toxicity to nearby normal tissue during RT, and can be used to evaluate the effectiveness of a treatment post-therapy. This chapter reviews the basic measures to estimate regional ventilation from image registration of CT images, the comparison of them to the existing golden standard and the application in radiation therapy.

  13. The role of bronchoscopy in the diagnosis of early lung cancer: a review.

    Science.gov (United States)

    Andolfi, Marco; Potenza, Rossella; Capozzi, Rosanna; Liparulo, Valeria; Puma, Francesco; Yasufuku, Kazuhiro

    2016-11-01

    Lung cancer is the leading cause of cancer-related deaths worldwide with an overall 5-year survival rate of 17% after diagnoses. Indeed many patients tend to have a very poor prognosis, due to being diagnosed at an advanced stage. Conversely patients who are diagnosed at an early stage have a 5-year survival >70%, indicating that early detection of lung cancer is crucial to improve survival. Although flexible bronchoscopy is a relatively non-invasive procedure for patients suspected of having lung cancer, only 29% of carcinoma in situ (CIS) and 69% of microinvasive tumors were detectable using white light bronchoscopy (WLB) alone. As a result, in the past two decades, new bronchoscopic techniques have been developed to increase the yield and diagnostic accuracy, such as autofluorescence bronchoscopy (AFB), narrow band imaging (NBI) and high magnification bronchovideoscopy (HMB). However, due to the low specificity and the limitation to detect only proximal bronchial tree, new probe-based technologies have been introduced: radial endobronchial ultrasound (R-EBUS), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE) and laser Raman spectroscopy (LRS). To date, although tissue biopsy remains the gold standard for diagnosing malignant/premalignant airway disease and some techniques are still investigational, bronchoscopic technologies can be considered the safest and most accurate tools to evaluate both central and distal airway mucosa.

  14. Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Iwano, Shingo, E-mail: iwano45@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan); Imaizumi, Kazuyoshi [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Okada, Tohru [Research Center for Charged Particle Therapy, National Institute of Radiological Science, 4-9-1 Anagawa, Inage-ku, Chiba 2638555 (Japan); Hasegawa, Yoshinori [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Naganawa, Shinji [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan)

    2011-07-15

    Objective: The aim of this study was to evaluate the clinical value of virtual bronchoscopy (VB) in aiding diagnosis of peripheral lung cancer by transbronchial biopsy (TBB). In addition, we sought to systematically analyze the factors that affect the diagnostic sensitivity of VB-guided TBB for the evaluation of peripheral lung cancers. Materials and methods: A hundred and twenty-two peripheral lung cancers from 122 patients (82 men and 40 women, 38-84 years; median 68.5 years) who were performed VB-guided TBB were evaluated retrospectively. VB was reconstructed from 1- or 0.5-mm slice thickness images of multi-detector CT (MDCT). Experienced pulmonologists inserted the conventional and ultrathin bronchoscopes into the target bronchus under direct vision following the VB image. Results: A definitive diagnosis was established by VB-guided TBB in 96 lesions (79%). The diagnostic sensitivity of small pulmonary lesions {<=}30 mm in maximal diameter (71%) was significantly lower than that of lesions >30 mm (91%, p = 0.008). For small pulmonary lesions {<=}30 mm (n = 76), internal opacity of the lesion was the independent predictor of diagnostic sensitivity by VB-guided TBB, and the non-solid type lung cancers were significantly lower than the solid type and part-solid type lung cancers for diagnostic sensitivity (odds ratio = 0.161; 95% confidence interval = 0.033-0.780; p = 0.023). Conclusion: Use of an ultrathin bronchoscope and simulation with VB reconstructed by high quality MDCT images is thought to improve pathological diagnosis of peripheral lung cancers, especially for solid and partly solid types. For small pulmonary lesions {<=}30 mm, the lesion internal opacity is a significant factor for predicting the diagnostic sensitivity, and the sensitivity was low for small non-solid type of lung cancers.

  15. Study of fetal lung volume using virtual organ computer aided analytical technique%三维超声体积自动测量技术对胎儿肺体积的研究

    Institute of Scientific and Technical Information of China (English)

    陈骊珠; 王晓光; 蔡爱露; 王冰

    2012-01-01

    Objective: To evaluate the correlation between fetal lung volumes and gestational age, and estimated fetal weight, and to evaluate the potential diagnostic value of ultrasound fetal lung to body weight ratio (UFLB) in fetal pulmonary hypoplasia (PH). Methods: The fetal lung volumes were assessed in 315 normal fetuses and 28 fetuses with high risk of PH using the technique of virtual organ computer-aided analysis (VOCAL). The relationships between the lung volumes and gestational age, and fetal weight were assessed by correlation and regression analysis. The value of UFLB in the diagnosis of fetal PH was acquired by compared with the postnatal findings. Results: Fetal lung volumes were highly correlated with gestational age(r=0.93,P<0.05), and with fetal weight(r=0.97,P<0.05). The sensitivity, specificity, positive and negative predictive values of UFLB in diagnosing fetal PH was 89.47%, 85.71%, 94.44% and 75.00%, respectively, and the accuracy was 88.46%. Conclusion: In normal fetuses, fetal lung volumes increase with gestational age and fetal weight. UFLB may be useful in the prenatal diagnosis of fetal PH.%目的:探讨正常孕中晚期胎儿肺体积随孕周、胎儿体重的变化规律,以及超声肺重比(UFLB)对胎儿肺发育不良(PH)的诊断价值.方法:超声检查315例正常胎儿和28例PH高危胎儿,应用三维超声体积自动测量(VOCAL)技术测量胎儿肺体积,采用二维超声测得的生物参数经Hadlock方程系统获得胎儿质量,计算得到胎儿UFLB,随访胎儿产后及引产结果,并与产前诊断结果作对照.结果:正常胎儿肺体积与胎儿质量(r=0.97,P<0.05)的相关性高于胎儿肺体积与孕周(r=0.93,P<0.05)的相关性.28例PH高危胎儿中,2例因羊水过少未能获得满意的三维图像,PH高危胎儿应用VOCAL技术获得肺体积的成功率为92.90%.在成功获得肺体积的26例胎儿中,应用UFLB诊断胎儿PH的敏感度为89.47%,特异度为85.71%,阳性预测值为94.44

  16. Lung disease

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000066.htm Lung disease To use the sharing features on this page, ... fibrosis and sarcoidosis are examples of lung tissue disease. Lung circulation diseases -- These diseases affect the blood vessels ...

  17. Lung transplant

    Science.gov (United States)

    Solid organ transplant - lung ... the chance that the body will reject the transplant . Lungs can also be given by living donors. ... the person who is receiving it. During lung transplant surgery, you are asleep and pain-free (under ...

  18. Collapsed Lung

    Science.gov (United States)

    A collapsed lung happens when air enters the pleural space, the area between the lung and the chest wall. If it is a ... is called pneumothorax. If only part of the lung is affected, it is called atelectasis. Causes of ...

  19. Effect of high volume mechanical ventilation on radiation-induced lung toxicity in rats%机械通气对大鼠照射后肺组织及细胞凋亡的影响

    Institute of Scientific and Technical Information of China (English)

    金胜; 陈军; 叶繁; 冯丹

    2015-01-01

    Objective To evaluate the effects of mechanical ventilation on radiation induced lung injuries of apoptosis,acute inflammation,and oxidative stress by establishing a rat mechanical ventilation model and animal model.Methods Totally 40 male Sprague-Dawley(SD) rats were randomly divided into 4 groups with 10 rats in each group:control,radiation alone,high tidal volume ventilation,and high tidal volume ventilation following by radiation.After treatment,the pathological changes in lung tissue were observed,NF-κB activity was detected by electrophoretic mobility shift assay (EMSA),the expression of NF-κB subunit P65 protein level in lung cell nucleus was detected by Western blot,and the apoptosis of lung cells was detected by terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) method.The wet to dry weight ratio (W/D) of lung,myeloperoxidase (MPO),malondialdehyde (MDA) and superoxide dismutase (SOD) were detected.In addition,the total protein and white blood cell number in lung lavage fluid were also measured.Results Compared to the control,the acute lung injury (ALI) score,W/D ratio,MPO activity,total protein level,white blood cell number,apoptosis index (AI),lung tissue MDA,NF-κB activity and P65 protein expression were increased significantly (q =0.000 32-0.004 81,P <0.05),while SOD values was decreased significantly (q =0.000 18-0.002 53,P <0.01),in other three groups.Compared with radiation and high tidal volume ventilation group,the above indexes were significantly higher (q =0.004 3-0.022 6,P < 0.05) but the SOD value was significantly lower (q =0.002 9-0.008 3,P < 0.05) than those in the high tidal volume ventilation plus radiation group.Conclusions High tidal volume ventilation delivered to the radiation group produced more transparent ventilator-induced lung injury (VILI) than the high tidal volume ventilation alone induced VILI including permeable pulmonary edema,acute inflammation,oxidative stress and apoptosis in

  20. Analysis of sedation on broncholiths through bronchoscope with holmiun laser%经支气管镜钬激光技术治疗支气管结石的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郭国华; 肖建宏; 彭锦芸; 宋彬

    2016-01-01

    bronchial stenosis, bronchiectasis, COPD, hilar calcifications, or mediastinal lymph node calcifications. Through bronchoscopy examination was performed in 12 cases, Broncholiths were found in 9 patients and granulomatous lesion wrapping hard lesions in 3 patients.12 cases were treated by using Dexmedeto-midine combined with Sufentanil for sedation through of bronchoscope with holmiun laser. Results All the operations were successful, the operation time 45~90 min, average 60 min . During the surgery, the patient have stable heart rate, oxygen saturation without falling, blood pressure is stable, stable hemodynamics, the patients did not complain of discomfort, without obvious heart and lung failure and other complications occurred, the operation without bleed-ing, pneumothorax, complications. All cases of postoperative respiratory system were improved after operation. The average time stay in hospital was (2.5 ± 1.4) days. Follow-up for 1~24 months (mean, 6 months) in 12 cases found no recurrence of stones and serious respiratory tract infection. Conclusions The method of Dexmedetomidine com-bined with Sufentanil for sedation on broncholiths through of bronchoscope with holmiun laser is safey, feasible and therapeutic effects were clearly, which provides a new method for the clinical on Broncholiths.

  1. The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes.

    Science.gov (United States)

    Emans, John B; Caubet, Jean François; Ordonez, Claudia L; Lee, Edward Y; Ciarlo, Michelle

    2005-09-01

    Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) in patients with combined spine and chest wall deformity with scoliosis and fused ribs. Report the efficacy and safety of expansion thoracostomy and VEPTR surgery in the treatment of thoracic insufficiency syndrome (TIS) associated with fused ribs. Traditional attitudes toward early-onset combined chest and spine deformity assume that thoracic deformity is best controlled by treatment directed at spine deformity, often involving early spinal arthrodesis. Campbell and others have heightened awareness of the interrelationship between lung, chest, and spine development during growth and characterized TIS as the inability of the thorax to support normal respiration or lung growth. Expansion thoracostomy and VEPTR insertion was developed to directly control both spine and chest wall deformity during growth, while permitting continued vertebral column and chest growth at an early stage. Multidisciplinary evaluation of children with combined spine and chest wall deformity included pediatric pulmonologist, thoracic, and orthopedic surgeon evaluations. One or more opening wedge expansion thoracostomies and placement of VEPTR devices were performed as described by Campbell, with repeated device lengthenings during growth. Parameters measured included Cobb angle, length of thoracic spine, CT-derived lung volumes, and in older children pulmonary function tests. Thirty-one patients with fused ribs and TIS were treated, 4 of whom had undergone prior spinal arthrodesis at other institutions with continued progression of deformity. In 30 patients, the spinal deformity was controlled and growth continued in the thoracic spine during treatment at rates similar to normals. Increased volume of the constricted hemithorax and total lung volumes obtained during expansion thoracostomy were maintained at follow-up. Complications included device migration, infection, and brachial plexus palsy. Expansion

  2. Spleen Volume Variation in Patients with Locally Advanced Non-Small Cell Lung Cancer Receiving Platinum-Based Chemo-Radiotherapy.

    Science.gov (United States)

    Wen, Shu Wen; Everitt, Sarah J; Bedő, Justin; Chabrot, Marine; Ball, David L; Solomon, Benjamin; MacManus, Michael; Hicks, Rodney J; Möller, Andreas; Leimgruber, Antoine

    2015-01-01

    There is renewed interest in the immune regulatory role of the spleen in oncology. To date, very few studies have examined macroscopic variations of splenic volume in the setting of cancer, prior to or during therapy, especially in humans. Changes in splenic volume may be associated with changes in splenic function. The purpose of this study was to investigate variations in spleen volume in NSCLC patients during chemo-radiotherapy. Sixty patients with stage I-IIIB NSCLC underwent radiotherapy (60 Gy/30 fractions) for six weeks with concomitant carboplatin/paclitaxel (Ca/P; n = 32) or cisplatin/etoposide (Ci/E; n = 28). A baseline PET/CT scan was performed within 2 weeks prior to treatment and during Weeks 2 and 4 of chemo-radiotherapy. Spleen volume was measured by contouring all CT slices. Significant macroscopic changes in splenic volume occurred early after the commencement of treatment. A significant decrease in spleen volume was observed for 66% of Ca/P and 79% of Ci/E patients between baseline and Week 2. Spleen volume was decreased by 14.2% for Ca/P (pspleen volume was still significantly decreased for Ca/P patients compared to baseline, while for Ci/E patients, spleen volume returned to above baseline levels. This is the first report demonstrating macroscopic changes in the spleen in NSCLC patients undergoing radical chemo-radiotherapy that can be visualized by non-invasive imaging.

  3. Liquid-based thin-layer cytology can be routinely used in samples obtained via fiberoptic bronchoscope.

    Science.gov (United States)

    Kobayashi, Yukihiro; Uehara, Takeshi; Ota, Hiroyoshi

    2011-01-01

    The aim of this study was to evaluate liquid-based preparations (LBP) as a replacement for conventional smears (CS) of bronchial brushing (BB) and transbronchial fine-needle aspiration (TBNA) samples obtained via fiberoptic bronchoscope. Bronchial brushing and TBNA samples were obtained from 62 and 33 patients by fiberoptic bronchoscopy, respectively. Liquid-based preparations were prepared from needle rinse after initial CS preparation. We compared cellularity, cell morphology, and background between the LBP and CS slides. Correspondence rates between LBP and CS diagnoses in the above 3 categories were 90.3% in the BB and 97.0% in the TBNA samples. If suspicious cases were regarded as malignant, correspondence rates reached 98.4 and 100%, respectively. Histological diagnoses by LBP were mostly the same as those by CS and by biopsy or operation samples. Morphologically, cells and nuclei were shrunk in the LBP; however, the shrinking was not severe enough to influence cytological diagnoses. Blood background and air-drying, which were observed on many of the CS slides, were not detected on the LBP slides. It is possible to use LBP for routine laboratory processing of BB and TBNA samples as a replacement for CS. Copyright © 2010 S. Karger AG, Basel.

  4. Magnetic resonance (MR) imaging for tumor staging and definition of tumor volumes on radiation treatment planning in nonsmall cell lung cancer: A prospective radiographic cohort study of single center clinical outcome.

    Science.gov (United States)

    Zhao, Dan; Hu, Qiaoqiao; Qi, Liping; Wang, Juan; Wu, Hao; Zhu, Guangying; Yu, Huiming

    2017-02-01

    We investigate the impact of magnetic resonance (MR) on the staging and radiotherapy planning for patients with nonsmall cell lung cancer (NSCLC).A total of 24 patients with NSCLC underwent MRI, which was fused with radiotherapy planning CT using rigid registration. Gross tumor volume (GTV) was delineated not only according to CT image alone (GTVCT), but also based on both CT and MR image (GTVCT/MR). For each patient, 2 conformal treatment plans were made according to GTVCT and GTVCT/MR, respectively. Dose-volume histograms (DVH) for lesion and normal organs were generated using both GTVCT and GTVCT/MR treatment plans. All patients were irradiated according to GTVCT/MR plan.Median volume of the GTVCT/MR and GTVCT were 105.42 cm and 124.45 cm, respectively, and the mean value of GTVCT/MR was significantly smaller than that of GTVCT (145.71 ± 145.04 vs 174.30 ± 150.34, P definition of tumor volume, reduces organs at risk dose and does not increase the local recurrence rate.

  5. Patterns of Local-Regional Failure in Completely Resected Stage IIIA(N2) Non-Small Cell Lung Cancer Cases: Implications for Postoperative Radiation Therapy Clinical Target Volume Design

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Wen [Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai (China); Fu, Xiao-Long, E-mail: xlfu1964@hotmail.com [Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai (China); Cai, Xu-Wei; Yang, Huan-Jun; Wu, Kai-Liang; Fan, Min [Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai (China); Xiang, Jia-Qing; Zhang, Ya-Wei; Chen, Hai-Quan [Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai (China)

    2014-04-01

    Purpose: To analyze patterns of local-regional failure (LRF) for completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) patients treated in our hospital and to propose a clinical target volume (CTV) for postoperative radiation therapy (PORT) in these patients. Methods and Materials: From 2005 to 2011, consecutive patients with pT1-3N2 NSCLC who underwent complete resection in our hospital but who did not receive PORT were identified. The patterns of first LRF were assessed and evaluated as to whether these areas would be encompassed by our proposed PORT CTV. Results: With a median follow-up of 24 months, 173 of 250 patients (69.2%) experienced disease recurrence. Of the 54 patients with LRF as the first event, 48 (89%) had recurrence within the proposed PORT CTV, and 6 (11%) had failures occurring both within and outside the proposed CTV (all of which occurred in patients with right-lung cancer). Ninety-three percent of failure sites (104 of 112) would have been contained within the proposed PORT CTV. For left-sided lung cancer, the most common lymph node station failure site was 4R, followed by 7, 4L, 6, 10L, and 5. For right-sided lung cancer, the most common site was station 2R, followed by 10R, 4R, and 7. Conclusions: LRF following complete surgery was an important and potentially preventable pattern of failure in stage IIIA(N2) patients. Ipsilateral superior mediastinal recurrences dominated for right-sided tumors, whereas left-sided tumors frequently involved the bilateral superior mediastinum. Most of the LRF sites would have been covered by the proposed PORT CTV. A prospective investigation of patterns of failure after PORT (following our proposed CTV delineation guideline) is presently underway and will be reported in a separate analysis.

  6. Automated lung segmentation of low resolution CT scans of rats

    Science.gov (United States)

    Rizzo, Benjamin M.; Haworth, Steven T.; Clough, Anne V.

    2014-03-01

    Dual modality micro-CT and SPECT imaging can play an important role in preclinical studies designed to investigate mechanisms, progression, and therapies for acute lung injury in rats. SPECT imaging involves examining the uptake of radiopharmaceuticals within the lung, with the hypothesis that uptake is sensitive to the health or disease status of the lung tissue. Methods of quantifying lung uptake and comparison of right and left lung uptake generally begin with identifying and segmenting the lung region within the 3D reconstructed SPECT volume. However, identification of the lung boundaries and the fissure between the left and right lung is not always possible from the SPECT images directly since the radiopharmaceutical may be taken up by other surrounding tissues. Thus, our SPECT protocol begins with a fast CT scan, the lung boundaries are identified from the CT volume, and the CT region is coregistered with the SPECT volume to obtain the SPECT lung region. Segmenting rat lungs within the CT volume is particularly challenging due to the relatively low resolution of the images and the rat's unique anatomy. Thus, we have developed an automated segmentation algorithm for low resolution micro-CT scans that utilizes depth maps to detect fissures on the surface of the lung volume. The fissure's surface location is in turn used to interpolate the fissure throughout the lung volume. Results indicate that the segmentation method results in left and right lung regions consistent with rat lung anatomy.

  7. Primary Malignant Melanoma of the Lung: A Case Report

    Directory of Open Access Journals (Sweden)

    Karagianni Evangelia

    2003-11-01

    Full Text Available Abstract Background Primary melanoma of the lung is an extremely rare pathological entity and sparsely reported in the literature. Case presentation A case of primary malignant melanoma of the lung in a 41-year-old female is reported. The clinical, radiological and histopathological features are discussed. The initial symptom was cough, whereas the chest radiography showed a round opacity of the right lung. The computed tomography of the chest revealed a well-demarcated mass lesion in the right upper lobe. Endobronchial mass causing obstruction of the upper lobar bronchus was the bronchoscopic finding. Patient underwent pneumonectomy. A diagnosis of melanoma was confirmed postoperatively after the immunohistochemistry. Primary nature of the tumour in the lung results from the demonstration of characteristic junctional pattern of melanoma cells beneath the bronchial epithelium on histopathology, and from exclusion of other potential primary sites in the clinical, paraclinical and laboratory examination. Conclusions Primary melanoma of the lung represents a rare pathological entity. Careful interpretation of histopathological information in correlation with all other findings from clinical and paraclinical studies can establish a diagnosis. Follow-up is necessary in order to diagnose potential dissemination or secondary sites of the disease. Due to the small number of cases reported in the literature, there is no experience on the management and the prognosis of the disease, but surgical resection remains the cornerstone of the treatment.

  8. Time-Adjusted Internal Target Volume: A Novel Approach Focusing on Heterogeneity of Tumor Motion Based on 4-Dimensional Computed Tomography Imaging for Radiation Therapy Planning of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nishibuchi, Ikuno [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima (Japan); Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Nakashima, Takeo; Ochi, Yusuke [Division of Radiation Therapy, Hiroshima University Hospital, Hiroshima (Japan); Takahashi, Ippei; Doi, Yoshiko; Kenjo, Masahiro; Kaneyasu, Yuko; Ozawa, Syuichi; Murakami, Yuji [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Wadasaki, Koichi [Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima (Japan); Nagata, Yasushi [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan)

    2014-08-01

    Purpose: To consider nonuniform tumor motion within the internal target volume (ITV) by defining time-adjusted ITV (TTV), a volume designed to include heterogeneity of tumor existence on the basis of 4-dimensional computed tomography (4D-CT). Methods and Materials: We evaluated 30 lung cancer patients. Breath-hold CT (BH-CT) and free-breathing 4D-CT scans were acquired for each patient. The tumors were manually delineated using a lung CT window setting (window, 1600 HU; level, −300 HU). Tumor in BH-CT images was defined as gross tumor volume (GTV), and the sum of tumors in 4D-CT images was defined as ITV-4D. The TTV images were generated from the 4D-CT datasets, and the tumor existence probability within ITV-4D was calculated. We calculated the TTV{sub 80} value, which is the percentage of the volume with a tumor existence probability that exceeded 80% on ITV-4D. Several factors that affected the TTV{sub 80} value, such as the ITV-4D/GTV ratio or tumor centroid deviation, were evaluated. Results: Time-adjusted ITV images were acquired for all patients, and tumor respiratory motion heterogeneity was visualized. The median (range) ITV-4D/GTV ratio and median tumor centroid deviation were 1.6 (1.0-4.1) and 6.3 mm (0.1-30.3 mm), respectively. The median TTV{sub 80} value was 43.3% (2.9-98.7%). Strong correlations were observed between the TTV{sub 80} value and the ITV-4D/GTV ratio (R=−0.71) and tumor centroid deviation (R=−0.72). The TTV images revealed the tumor motion pattern features within ITV. Conclusions: The TTV images reflected nonuniform tumor motion, and they revealed the tumor motion pattern features, suggesting that the TTV concept may facilitate various aspects of radiation therapy planning of lung cancer while incorporating respiratory motion in the future.

  9. Lung malignancy: Diagnostic accuracies of bronchoalveolar lavage, bronchial brushing, and fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    Rateesh Sareen

    2016-01-01

    Full Text Available Background: Early diagnosis of lung cancer plays a pivotal role in reducing lung cancer death rate. Cytological techniques are safer, economical and provide quick results. Bronchoscopic washing, brushing and fine needle aspirations not only complement tissue biopsies in the diagnosis of lung cancer but also comparable. Objectives: (1 To find out diagnostic yields of bronchioalveolar lavage , bronchial brushings, FNAC in diagnosis of lung malignancy. (2 To compare relative accuracy of these three cytological techniques. (3 To correlate the cytologic diagnosis with clinical, bronchoscopic and CT findings. (4 Cytological and histopathological correlation of lung lesions. Methods: All the patients who came with clinical or radiological suspicion of lung malignancy in two and a half year period were included in study. Bronchoalveolar lavage was the most common type of cytological specimen (82.36%, followed by CT guided FNAC (9.45% and bronchial brushings (8.19%. Sensitivity, specificity, positive and negative predictive value for all techniques and correlation with histopathology was done using standard formulas. Results: The most sensitive technique was CT FNAC – (87.25% followed by brushings (77.78% and BAL (72.69%. CT FNAC had highest diagnostic yield (90.38%, followed by brushings (86.67% and BAL (83.67%. Specificity and positive predictive value were 100 % each of all techniques. Lowest false negatives were obtained in CT FNAC (12.5% and highest in BAL (27.3%. Highest negative predictive value was of BAL 76.95 % followed by BB 75.59% and CT FNAC 70.59%. Conclusion: Before administering antitubercular treatment every effort should be made to rule out malignancy. CT FNAC had highest diagnostic yield among three cytological techniques. BAL is an important tool in screening central as well as in accessible lesions. It can be used at places where CT guided FNAC is not available or could not be done due to technical or financial limitations

  10. Lung malignancy: Diagnostic accuracies of bronchoalveolar lavage, bronchial brushing, and fine needle aspiration cytology

    Science.gov (United States)

    Sareen, Rateesh; Pandey, C L

    2016-01-01

    Background: Early diagnosis of lung cancer plays a pivotal role in reducing lung cancer death rate. Cytological techniques are safer, economical and provide quick results. Bronchoscopic washing, brushing and fine needle aspirations not only complement tissue biopsies in the diagnosis of lung cancer but also comparable. Objectives: (1) To find out diagnostic yields of bronchioalveolar lavage, bronchial brushings, FNAC in diagnosis of lung malignancy. (2) To compare relative accuracy of these three cytological techniques. (3) To correlate the cytologic diagnosis with clinical, bronchoscopic and CT findings. (4) Cytological and histopathological correlation of lung lesions. Methods: All the patients who came with clinical or radiological suspicion of lung malignancy in two and a half year period were included in study. Bronchoalveolar lavage was the most common type of cytological specimen (82.36%), followed by CT guided FNAC (9.45%) and bronchial brushings (8.19%). Sensitivity, specificity, positive and negative predictive value for all techniques and correlation with histopathology was done using standard formulas. Results: The most sensitive technique was CT FNAC – (87.25%) followed by brushings (77.78%) and BAL (72.69%). CT FNAC had highest diagnostic yield (90.38%), followed by brushings (86.67%) and BAL (83.67%). Specificity and positive predictive value were 100 % each of all techniques. Lowest false negatives were obtained in CT FNAC (12.5%) and highest in BAL (27.3%). Highest negative predictive value was of BAL 76.95 % followed by BB 75.59% and CT FNAC 70.59%. Conclusion: Before administering antitubercular treatment every effort should be made to rule out malignancy. CT FNAC had highest diagnostic yield among three cytological techniques. BAL is an important tool in screening central as well as in accessible lesions. It can be used at places where CT guided FNAC is not available or could not be done due to technical or financial limitations PMID:27890992

  11. Epidermal Growth Factor Receptor Mutation in a Patient with Squamous Cell Carcinoma of the Lung: Who Should Be Tested

    Directory of Open Access Journals (Sweden)

    Michael Schwitter

    2013-05-01

    Full Text Available We report the case of a 64-year-old ex-smoker with metastatic poorly differentiated squamous cell carcinoma (SCC of the lung and an epidermal growth factor receptor (EGFR mutation in exon 21 (p.L858R who achieved prolonged clinical benefit from treatment with an EGFR tyrosine kinase inhibitor (TKI. The initial diagnosis of SCC of the lung obtained by bronchoscopic biopsy was based on immunohistochemical staining only with positivity for cytokeratin (CK 5/6 and p63 because morphological diagnosis was not possible. Patients with non-small cell lung cancer (NSCLC, not otherwise specified (NOS favouring SCC are usually not tested for the presence of EGFR mutations, and therefore may not receive EGFR TKI therapy. A bronchoscopic rebiopsy showed small nests of undifferentiated tumour cells with weak immunoreactivity of some tumour cells for CK5/6, p63 and no positivity of some tumour cells for thyroid transcription factor-1. These findings suggested a mixed squamous/glandular immunophenotype that has been missed at the initial biopsy. Our clinical case illustrates the problem of tumour heterogeneity encountered in small bronchoscopic biopsies and the difficulties of evaluating the histological subtype in poorly differentiated carcinomas. Initial bronchoscopy should be performed by an experienced pulmonologist who attempts to obtain sufficient material from different areas of the tumour. In the era of targeted therapy, a remote smoking history in a patient with NOS favouring SCC should also lead to EGFR mutation testing to allow highly effective therapy to be offered to mutation-positive patients.

  12. Long-term Exposure to PM10 and NO2 in Association with Lung Volume and Airway Resistance in the MAAS Birth Cohort

    OpenAIRE

    2013-01-01

    Background: Findings from previous studies on the effects of air pollution exposure on lung function during childhood have been inconsistent. A common limitation has been the quality of exposure data used, and few studies have modeled exposure longitudinally throughout early life. Objectives: We sought to study the long-term effects of exposure to particulate matter with an aerodynamic diameter ≤ 10 μm (PM10) and to nitrogen dioxide (NO2) on specific airway resistance (sRaw) and forced expira...

  13. Simultaneous in vivo synchrotron radiation computed tomography of regional ventilation and blood volume in rabbit lung using combined K-edge and temporal subtraction

    Energy Technology Data Exchange (ETDEWEB)

    Suhonen, H [Department of Physical Sciences, University of Helsinki (Finland); Porra, L [Department of Physical Sciences, University of Helsinki (Finland); Bayat, S [Universite de Picardie Jules Verne, Faculte de Medecine, PERITOX (EA-INI RIS) and Cardiologie et Pneumo-Allerglogie Pediatriques, CHU Amiens (France); Sovijaervi, A R A [Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki (Finland); Suortti, P [Department of Physical Sciences, University of Helsinki (Finland)

    2008-02-07

    In K-edge subtraction (KES) imaging with synchrotron radiation computed tomography (SRCT), two images are taken simultaneously using energies above and below the K-absorption edge of a contrast agent. A logarithmic difference image reveals the contrast agent concentration with good accuracy. Similarly, in temporal subtraction imaging (TSI) the reference image is taken before the introduction of the contrast agent. Quantitative comparisons of in vivo images of rabbit lung indicated that similar results for concentrations of iodine in blood vessels and xenon in airways are obtained by KES and TSI, but the level of noise and artifacts was higher in the latter. A linear fit showed that in the lung parenchyma {rho}{sub TSI} = (0.97 {+-} 0.03){rho}{sub KES} + (0.00 {+-} 0.05) for xenon and {rho}{sub TSI} = (1.21 {+-} 0.15){rho}{sub KES} + (0.0 {+-} 0.1) for iodine. For xenon the calculation of time constant of ventilation gave compatible values for both of the methods. The two methods are combined for the simultaneous determination of the xenon concentration (by KES) and the iodine concentration (by TSI) in lung imaging, which will allow simultaneous in vivo determination of ventilation and perfusion.

  14. Lung cancer screening beyond low-dose computed tomography: the role of novel biomarkers.

    Science.gov (United States)

    Hasan, Naveed; Kumar, Rohit; Kavuru, Mani S

    2014-10-01

    Lung cancer is the most common and lethal malignancy in the world. The landmark National lung screening trial (NLST) showed a 20% relative reduction in mortality in high-risk individuals with screening low-dose computed tomography. However, the poor specificity and low prevalence of lung cancer in the NLST provide major limitations to its widespread use. Furthermore, a lung nodule on CT scan requires a nuanced and individualized approach towards management. In this regard, advances in high through-put technology (molecular diagnostics, multi-gene chips, proteomics, and bronchoscopic techniques) have led to discovery of lung cancer biomarkers that have shown potential to complement the current screening standards. Early detection of lung cancer can be achieved by analysis of biomarkers from tissue samples within the respiratory tract such as sputum, saliva, nasal/bronchial airway epithelial cells and exhaled breath condensate or through peripheral biofluids such as blood, serum and urine. Autofluorescence bronchoscopy has been employed in research setting to identify pre-invasive lesions not identified on CT scan. Although these modalities are not yet commercially available in clinic setting, they will be available in the near future and clinicians who care for patients with lung cancer should be aware. In this review, we present up-to-date state of biomarker development, discuss their clinical relevance and predict their future role in lung cancer management.

  15. 三维超声测量胎儿肺容积的准确性研究%Accuracy of Fetal Lung Volume Assessed by Three-dimensional Sonography

    Institute of Scientific and Technical Information of China (English)

    张波; 杨太珠

    2011-01-01

    Objective To assess the value of 3D ultrasound in fetal lung volume measurement using VOCAL technique,and to determine its accuracy and reproducibility.Methods Fetal lung volumes were measured using VOCAL technique in 14 cases with pulmonary hypoplasia and in 17 controls 1-3 days before termination.Postmortem autopsy was conducted within 6 hours after labor and the lung volume was achieved by water displacement.Results The correlation between measured volume and postmortem examination was significant,with correlation coefficient 0.80 in pathological cases and 0.96 in controls.The mean relative error, bias, 95% limits of agreement were, respectively,-2.31%, -0.19 cm3 and ( - 3.59-3.20) cm3 in cases with pulmonary hypoplasia and - 1.06%, - 0.37 cm3 and (-6.12-5.38) cm3 in controls.Good intraobserver and interobserver reproducibility were achieved, both in pathological cases and in controls.Conclusions Prenatal 3D ultrasound can estimate accurately fetal lung volume using VOCAL technique, both in normal and pathological situation ,which conduces to evaluation of its physiological development.%目的 探讨三维超声VOCAL技术在胎儿肺容积测量中的应用价值,并评价其准确性及重复性.方法 收集拟引产胎儿31例,其中病理组(有肺发育不良高危因素)14例,对照组(无肺发育不良高危因素)17例.引产前1~3 d应用VOCAL法分别测得胎儿左、右肺容积值,相加得到总肺容积,引产后6 h内对胎儿进行病理检查,应用水置换法得到其实际总肺容积.结果 (1)三维超声测值与病理检查结果间有良好的相关性,病理组与对照组的相关系数(r)分别为0.80及0.96(P均<0.01);(2)三维超声测量病理组胎肺容积的平均相对误差,偏倚及95%一致性界限分别为-2.31%、-0.19 cm3及(-3.59~3.20)cm3,而对照组分别为-1.06%、-0.37 cm3及(-6.12~5.38)cm3;(3)三维超声对病理组及对照组胎肺容积进行测量时的操作者内及操作者间变异较小,

  16. Multipotent adult progenitor cells decrease cold ischemic injury in ex vivo perfused human lungs: an initial pilot and feasibility study.

    Science.gov (United States)

    La Francesca, Saverio; Ting, Anthony E; Sakamoto, Jason; Rhudy, Jessica; Bonenfant, Nicholas R; Borg, Zachary D; Cruz, Fernanda F; Goodwin, Meagan; Lehman, Nicholas A; Taggart, Jennifer M; Deans, Robert; Weiss, Daniel J

    2014-01-01

    Primary graft dysfunction (PGD) is a significant cause of early morbidity and mortality following lung transplantation. Improved organ preservation techniques will decrease ischemia-reperfusion injury (IRI) contributing to PGD. Adult bone marrow-derived adherent stem cells, including mesenchymal stromal (stem) cells (MSCs) and multipotent adult progenitor cells (MAPCs), have potent anti-inflammatory actions, and we thus postulated that intratracheal MAPC administration during donor lung processing would decrease IRI. The goal of the study was therefore to determine if intratracheal MAPC instillation would decrease lung injury and inflammation in an ex vivo human lung explant model of prolonged cold storage and subsequent reperfusion. Four donor lungs not utilized for transplant underwent 8 h of cold storage (4°C). Following rewarming for approximately 30 min, non-HLA-matched allogeneic MAPCs (1 × 10(7) MAPCs/lung) were bronchoscopically instilled into the left lower lobe (LLL) and vehicle comparably instilled into the right lower lobe (RLL). The lungs were then perfused and mechanically ventilated for 4 h and subsequently assessed for histologic injury and for inflammatory markers in bronchoalveolar lavage fluid (BALF) and lung tissue. All LLLs consistently demonstrated a significant decrease in histologic and BALF inflammation compared to vehicle-treated RLLs. These initial pilot studies suggest that use of non-HLA-matched allogeneic MAPCs during donor lung processing can decrease markers of cold ischemia-induced lung injury.

  17. Epidemiology of Lung Function and Chronic Obstructive Pulmonary Disease

    NARCIS (Netherlands)

    D.W. Loth (Daan)

    2013-01-01

    textabstractSpirometry is a technique to evaluate the pulmonary ventilatory function and is a reflection of several forces implied in lung volumes. The lung volume is dependent on the elastic recoil of the lungs and chest wall and the muscular efforts of the chest wall, diaphragm, and abdomen.

  18. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung.

    Science.gov (United States)

    Lohser, Jens; Slinger, Peter

    2015-08-01

    Lung injury is the leading cause of death after thoracic surgery. Initially recognized after pneumonectomy, it has since been described after any period of 1-lung ventilation (OLV), even in the absence of lung resection. Overhydration and high tidal volumes were thought to be responsible at various points; however, it is now recognized that the pathophysiology is more complex and multifactorial. All causative mechanisms known to trigger ventilator-induced lung injury have been described in the OLV setting. The ventilated lung is exposed to high strain secondary to large, nonphysiologic tidal volumes and loss of the normal functional residual capacity. In addition, the ventilated lung experiences oxidative stress, as well as capillary shear stress because of hyperperfusion. Surgical manipulation and/or resection of the collapsed lung may induce lung injury. Re-expansion of the collapsed lung at the conclusion of OLV invariably induces duration-dependent, ischemia-reperfusion injury. Inflammatory cytokines are released in response to localized injury and may promote local and contralateral lung injury. Protective ventilation and volatile anesthesia lessen the degree of injury; however, increases in biochemical and histologic markers of lung injury appear unavoidable. The endothelial glycocalyx may represent a common pathway for lung injury creation during OLV, because it is damaged by most of the recognized lung injurious mechanisms. Experimental therapies to stabilize the endothelial glycocalyx may afford the ability to reduce lung injury in the future. In the interim, protective ventilation with tidal volumes of 4 to 5 mL/kg predicted body weight, positive end-expiratory pressure of 5 to 10 cm H2O, and routine lung recruitment should be used during OLV in an attempt to minimize harmful lung stress and strain. Additional strategies to reduce lung injury include routine volatile anesthesia and efforts to minimize OLV duration and hyperoxia.

  19. Integration of interventional bronchoscopy in the management of lung cancer

    Directory of Open Access Journals (Sweden)

    Nicolas Guibert

    2015-09-01

    Full Text Available Tracheal or bronchial proximal stenoses occur as complications in 20–30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as “thermal” techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1 the available methods for assessing the characteristics of stenoses before treatment, 2 the various techniques available including their preferred indications, outcomes and complications, and 3 the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy.

  20. Integration of interventional bronchoscopy in the management of lung cancer.

    Science.gov (United States)

    Guibert, Nicolas; Mazieres, Julien; Marquette, Charles-Hugo; Rouviere, Damien; Didier, Alain; Hermant, Christophe

    2015-09-01

    Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).

  1. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    Science.gov (United States)

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (pmanagement of patients with difficult airways.

  2. 21 CFR 868.2450 - Lung water monitor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Lung water monitor. 868.2450 Section 868.2450 Food... DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2450 Lung water monitor. (a) Identification. A lung water monitor is a device used to monitor the trend of fluid volume changes in a patient's lung...

  3. Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    Directory of Open Access Journals (Sweden)

    Andrea de Melo Alexandre Fraga

    2008-02-01

    Full Text Available OBJETIVO: Descrever manifestações clínicas e tratamento broncoscópico da aspiração de corpo estranho em crianças menores de 14 anos de idade, correlacionando com achados broncoscópicos. MÉTODOS: Estudo retrospectivo, descritivo analisando prontuários de todas as crianças menores de 14 anos de idade atendidas no Hospital das Clinicas da Universidade Estadual de Campinas de janeiro de 2000 a dezembro de 2005, submetidas à broncoscopia por suspeita clínica de aspiração de corpo estranho. RESULTADOS: Foram analisados 69 pacientes, com idade entre 8 meses e 12 anos/7 meses (75,4% abaixo de 3 anos, dos quais 62,3% eram do sexo masculino. A principal queixa foi tosse súbita (75,4%. Em 74% dos casos houve alteração de ausculta pulmonar e dispnéia foi observada em 20 crianças (29%. Um total de 88% apresentou alteração radiológica. A aspiração ocorreu predominantemente em pulmão direito (54,8%, com material de origem vegetal, destacando feijão e amendoim (30,7%. Complicações ocorreram em 29% dos pacientes, sendo pneumonia a mais comum, e foram associadas ao tempo maior de aspiração (p = 0,03. Um total de 7 pacientes (10,1% necessitaram ventilação mecânica, e 5 (7,2% foram submetidos a mais de uma broncoscopia. CONCLUSÃO: História clínica com início súbito de engasgo e tosse, anormalidades na ausculta pulmonar e na radiografia de tórax caracterizam o quadro clínico de aspiração e são indicativas de broncoscopia. Quanto maior o tempo de aspiração, maior o risco de complicações. A alta prevalência de corpos estranhos de origem vegetal alerta para a necessidade de programas preventivos dirigidos aos menores de 3 anos.OBJECTIVE: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. METHODS: A retrospective, descriptive study analyzing data related to children under 14

  4. The use of surfactant in lung transplantation.

    Science.gov (United States)

    Amital, Anat; Shitrit, David; Raviv, Yael; Saute, Milton; Medalion, Benjamin; Bakal, Llana; Kramer, Mordechai R

    2008-12-15

    Lung transplantation impairs surfactant activity, which may contribute to primary graft dysfunction (PGD). Prompted by studies in animals and a few reports in humans, this study sought to determine if the administration of surfactant during transplantation serves as an effective preventive measure. An open, randomized, controlled prospective design was used. Forty-two patients scheduled for single (n=38) or double (n=4) lung transplantation at a major tertiary medical center were randomly assigned to receive, or not, intraoperative surfactant treatment. In the treated group, bovine surfactant was administered at a dose of 20 mg phospholipids/kg through bronchoscope after the establishment of bronchial anastomosis. The groups were compared for oxygenation (PaO2/FiO2), chest X-ray findings, PGD grade, and outcome. Compared with the untreated group, the patients who received surfactant were characterized by better postoperative oxygenation mean PaO2/FiO2 (418.8+/-123.8 vs. 277.9+/-165 mm Hg, P=0.004), better chest radiograph score, a lower PGD grade (0.66 vs. 1.86, P=0.005), fewer cases of severe PGD (1 patient vs. 12, P<0.05), earlier extubation (by 2.2 hr; 95% CI 1.1-4.3 hr, P=0.027), shorter intensive care unit stay (by 2.3 days; 95% CI 1.47-3.74 days, P=0.001), and better vital capacity at 1 month (61% vs. 50%, P=0.022). One treated and 2 untreated patients died during the first postoperative month. Surfactant instillation during lung transplantation improves oxygenation, prevents PGD, shortens intubation time, and enhances early posttransplantation recovery. Further, larger studies are needed to assess whether surfactant should be used routinely in lung transplantation.

  5. Hyperpolarized 3He apparent diffusion coefficient MRI of the lung: reproducibility and volume dependency in healthy volunteers and patients with emphysema

    DEFF Research Database (Denmark)

    Diaz, S.; Casselbrant, I.; Piitulainen, E.;

    2008-01-01

    PURPOSE: To measure the apparent diffusion coefficient (ADC) of hyperpolarized (HP) (3)He gas using diffusion weighted MRI in healthy volunteers and patients with emphysema and examine the reproducibility and volume dependency. MATERIALS AND METHODS: A total of eight healthy volunteers and 16...... days was good in both healthy volunteers and patients (SD range of 0.003-0.013 cm(2)/second and 0.001-0.009 cm(2)/second at 6% and 15% of TLC for healthy volunteers, and a SD range of 0.001-0.041 cm(2)/second and 0.001-0.011 cm(2)/second, respectively, for patients). A minor but significant increase...... in mean ADC with increased inhaled gas volume was observed in both groups. CONCLUSION: Mean ADC and SD of HP (3)He MRI is reproducible and discriminates well between healthy controls and patients with emphysema at the higher gas volume. This method is robust and may be useful to gain new insights...

  6. Increased mean lung density: Another independent predictor of lung cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Sverzellati, Nicola, E-mail: nicola.sverzellati@unipr.it [Department of Department of Surgical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma (Italy); Randi, Giorgia, E-mail: giorgia.randi@marionegri.it [Department of Epidemiology, Mario Negri Institute, Via La Masa 19, 20156 Milan (Italy); Spagnolo, Paolo, E-mail: paolo.spagnolo@unimore.it [Respiratory Disease Unit, Center for Rare Lung Disease, Department of Oncology, Hematology and Respiratory Disease, University of Modena and Reggio Emilia, Via del Pozzo 71, 44124 Modena (Italy); Marchianò, Alfonso, E-mail: alfonso.marchiano@istitutotumori.mi.it [Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan (Italy); Silva, Mario, E-mail: mac.mario@hotmail.it [Department of Department of Surgical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma (Italy); Kuhnigk, Jan-Martin, E-mail: Jan-Martin.Kuhnigk@mevis.fraunhofer.de [Fraunhofer MEVIS, Universitaetsallee 29, 28359 Bremen (Germany); La Vecchia, Carlo, E-mail: carlo.lavecchia@marionegri.it [Department of Occupational Health, University of Milan, Via Venezian 1, 20133 Milan (Italy); Zompatori, Maurizio, E-mail: maurizio.zompatori@unibo.it [Department of Radiology, Cardio-Thoracic Section, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna (Italy); Pastorino, Ugo, E-mail: ugo.pastorino@istitutotumori.mi.it [Department of Surgery, Section of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan (Italy)

    2013-08-15

    Objectives: To investigate the relationship between emphysema phenotype, mean lung density (MLD), lung function and lung cancer by using an automated multiple feature analysis tool on thin-section computed tomography (CT) data. Methods: Both emphysema phenotype and MLD evaluated by automated quantitative CT analysis were compared between outpatients and screening participants with lung cancer (n = 119) and controls (n = 989). Emphysema phenotype was defined by assessing features such as extent, distribution on core/peel of the lung and hole size. Adjusted multiple logistic regression models were used to evaluate independent associations of CT densitometric measurements and pulmonary function test (PFT) with lung cancer risk. Results: No emphysema feature was associated with lung cancer. Lung cancer risk increased with decreasing values of forced expiratory volume in 1 s (FEV{sub 1}) independently of MLD (OR 5.37, 95% CI: 2.63–10.97 for FEV{sub 1} < 60% vs. FEV{sub 1} ≥ 90%), and with increasing MLD independently of FEV{sub 1} (OR 3.00, 95% CI: 1.60–5.63 for MLD > −823 vs. MLD < −857 Hounsfield units). Conclusion: Emphysema per se was not associated with lung cancer whereas decreased FEV{sub 1} was confirmed as being a strong and independent risk factor. The cross-sectional association between increased MLD and lung cancer requires future validations.

  7. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial.

    Science.gov (United States)

    Fraser, John F; Spooner, Amy J; Dunster, Kimble R; Anstey, Chris M; Corley, Amanda

    2016-08-01

    Patients with COPD using long-term oxygen therapy (LTOT) over 15 h per day have improved outcomes. As inhalation of dry cold gas is detrimental to mucociliary clearance, humidified nasal high flow (NHF) oxygen may reduce frequency of exacerbations, while improving lung function and quality of life in this cohort. In this randomised crossover study, we assessed short-term physiological responses to NHF therapy in 30 males chronically treated with LTOT. LTOT (2-4 L/min) through nasal cannula was compared with NHF at 30 L/min from an AIRVO through an Optiflow nasal interface with entrained supplemental oxygen. Comparing NHF with LTOT: transcutaneous carbon dioxide (TcCO2) (43.3 vs 46.7 mm Hg, ptranscutaneous oxygen (TcO2) (97.1 vs 101.2 mm Hg, p=0.01), I:E ratio (0.75 vs 0.86, p=0.02) and respiratory rate (RR) (15.4 vs 19.2 bpm, p<0.001) were lower; and tidal volume (Vt) (0.50 vs 0.40, p=0.003) and end-expiratory lung volume (EELV) (174% vs 113%, p<0.001) were higher. EELV is expressed as relative change from baseline (%Δ). Subjective dyspnoea and interface comfort favoured LTOT. NHF decreased TcCO2, I:E ratio and RR, with a concurrent increase in EELV and Vt compared with LTOT. This demonstrates a potential mechanistic rationale behind the improved outcomes observed in long-term treatment with NHF in oxygen-dependent patients. ACTRN12613000028707. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Lung surgery

    Science.gov (United States)

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  9. The aging lung

    Directory of Open Access Journals (Sweden)

    Lowery EM

    2013-11-01

    Full Text Available Erin M Lowery,1 Aleah L Brubaker,2 Erica Kuhlmann,1 Elizabeth J Kovacs31Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine at Loyola University Medical Center, 2Loyola University Stritch School of Medicine, 3Department of Surgery, Loyola University Medical Center, Maywood, IL, USAAbstract: There are many age-associated changes in the respiratory and pulmonary immune system. These changes include decreases in the volume of the thoracic cavity, reduced lung volumes, and alterations in the muscles that aid respiration. Muscle function on a cellular level in the aging population is less efficient. The elderly population has less pulmonary reserve, and cough strength is decreased in the elderly population due to anatomic changes and muscle atrophy. Clearance of particles from the lung through the mucociliary elevator is decreased and associated with ciliary dysfunction. Many complex changes in immunity with aging contribute to increased susceptibility to infections including a less robust immune response from both the innate and adaptive immune systems. Considering all of these age-related changes to the lungs, pulmonary disease has significant consequences for the aging population. Chronic lower respiratory tract disease is the third leading cause of death in people aged 65 years and older. With a large and growing aging population, it is critical to understand how the body changes with age and how this impacts the entire respiratory system. Understanding the aging process in the lung is necessary in order to provide optimal care to our aging population. This review focuses on the nonpathologic aging process in the lung, including structural changes, changes in muscle function, and pulmonary immunologic function, with special consideration of obstructive lung disease in the elderly.Keywords: aging, lung, pulmonary immunology, COPD

  10. Surfactant as salvage therapy in life threatening primary graft dysfunction in lung transplantation.

    Science.gov (United States)

    Amital, Anat; Shitrit, David; Raviv, Yael; Saute, Milton; Bakal, Ilana; Medalion, Benjamin; Kramer, Mordechai R

    2009-02-01

    Impaired surfactant activity may contribute to primary graft dysfunction after lung transplantation. We assessed the role of surfactant treatment in lung transplant recipients with severe life threatening primary lung graft dysfunction. Five patients after lung transplantation: 4 after single-lung transplantation, for emphysema (n=3) or idiopathic pulmonary fibrosis (n=1), and 1 patient after double-lung transplantation for cystic fibrosis. All had severe life threatening primary graft dysfunction that failed to respond to conventional measures. Treatment consisted of bronchoscopic instillation of mammalian surfactant, 20-90cc, at 3 (n=1) or 7 days (n=4) after transplantation. There was a significant improvement in the ratio of partial arterial oxygen tension (PaO(2)) to fractional concentration of oxygen in inspired gas (FIO(2)), from a mean of 98.8+/-21.7 to 236.8+/-52.3 mmHg (p=0.0006), within hours of treatment. All were eventually discharged home and showed a satisfactory FEV(1) (44-67% predicted) at the 6-month follow-up. All patients were still alive 6 months or more after transplantation. Surfactant treatment improves oxygenation and may be life saving in patients with primary lung graft dysfunction.

  11. Narcoanalysis of pneumonorestion with video-assisted thoracic surgery during one-lung ventilation

    Institute of Scientific and Technical Information of China (English)

    Lairong Sun; Lianbing Gu

    2012-01-01

    Objective: The aim of our study was to analyze the anesthesia of pneumonoresection in lung cancer patients with video-assisted thoracic surgery during one-lung ventilation. Methods: After fast-speed venous induced anesthesia, double-lumen bronchial catheter or endobronchial blocker tube were intubated in 551 patients, the position of double-lumen endobronchial tube or single lumen tube + endobronchial blocker tube was confirmed with fiber-optic bronchoscope after intubation. Interstitial positive pressure ventilation were used in all patients with video-assisted thoracic surgery (VATS) interstitial positive pressure ventilation, positive end expiratory pressure and continuous positive airway pressure in collapse lobers of lung were used in one lung ventilation, and ventilation parameters were adjusted necessarily. Results: 541 cases double-tubes bronchial catheter intubation and endobronchial blocker tube used by fiberscope were located very well. The level of SPO2, PEtCO2 could be maintained normal. Ten cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 4 cases pulmonary adhesion, 4 cases severe pulmonary dysfunction hard to correct hyoxemia and 2 case abnormal anatomy respectively. Conclusion: Anesthesia key of video-assisted thoracic surgery is that double lung must separated completely. Effective management of one lung ventilation could make patients to pass perioperation smoothly. Long-time one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction should be considered to be relative contraindication.

  12. The effect of late-phase contrast enhancement on semi-automatic software measurements of CT attenuation and volume of part-solid nodules in lung adenocarcinomas

    NARCIS (Netherlands)

    Cohen, J.G.; Goo, J.M.; Yoo, R.E.; Park, S.B.; Ginneken, B. van; Ferretti, G.R.; Lee, C.H.; Park, C.M.

    2016-01-01

    OBJECTIVES: To evaluate the differences in semi-automatic measurements of CT attenuation and volume of part-solid nodules (PSNs) between unenhanced and enhanced CT scans. MATERIALS AND METHODS: CT scans including unenhanced and enhanced phases (slice thickness 0.625 and 1.25mm, respectively) for 53

  13. Lung-protective ventilation in neonatology.

    Science.gov (United States)

    van Kaam, Anton

    2011-01-01

    Ventilator-induced lung injury (VILI) is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD) and is primarily caused by overdistension (volutrauma) and repetitive opening and collapse (atelectrauma) of terminal lung units. Lung-protective ventilation should therefore aim to reduce tidal volumes, and recruit and stabilize atelectatic lung units (open lung ventilation strategy). This review will summarize the available evidence on lung-protective ventilation in neonatology, discussing both high-frequency ventilation (HFV) and positive pressure ventilation (PPV). It shows that HFV does not appear to have a clear benefit over PPV, although most studies failed to apply a true open lung ventilation strategy during HFV. The evidence on the optimal tidal volume, positive end-expiratory pressure and the role for lung recruitment during lung-protective PPV is extremely limited. Volume-targeted ventilation seems to be a promising mode in terms of lung protection, but more studies are needed. Due to the lack of convincing evidence, lung-protective ventilation and modes seem to be implemented in daily clinical practice at a slow pace.

  14. Pitfalls and Challenges of Lung Transplant in a Patient With Kartagener Syndrome and Scoliosis.

    Science.gov (United States)

    Yazicioglu, Alkin; Alici, Ibrahim Onur; Karaoglanoglu, Nurettin; Yekeler, Erdal

    2016-03-14

    We present a 22-year-old woman with Kartagener syndrome and scoliosis who died 112 days after single lung transplant. The classic thoracic involvement of situs inversus totalis and the asymmetric arrangement of the thoracic vascular structures might be a pitfall for surgeon. Anatomic obstacles have forced the surgeon to perform a single transplant. The period of primary graft dysfunction in a single transplanted lung patient was a challenge; supporting the patient with a high flow and long period of extracorporeal membrane oxygenation might lead to a vanishing bronchus. Immotile cilia, a feature of Kartagener syndrome, were another challenge and patient needed several daily aspiration bronchoscopies. Vanishing bronchus is a gradual process with high mortality rates; commonly, stenosis is at the non anastomotic bronchial tree because of insufficient nourishment of the bronchial cartilages. Several repeat bronchoscopic balloon dilatations accompanied with medical treatment were unsuccessful.

  15. Lung function

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005200 The effect of body position changes on lung function, lung CT imaging and pathology in an oleic acid induced acute lung injury model. JI Xin-ping (戢新平), et al. Dept Emergency, 1st Affili Hosp, China Med Univ, Shenyang 110001. Chin J Tuberc Respir Dis, 2005;28(1) :33-36. Objective: To study the effect of body position changes on lung mechanics, oxygenation, CT images and pathology in an oleic acid-induced acute lung injury (ALl) model. Methods: The study groups con-

  16. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model

    Science.gov (United States)

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning

    2017-01-01

    Introduction Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. Methods The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. Results During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to –2, –6 and –17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Conclusions Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure). PMID:28725445

  17. Lung and Heart Dose Variability During Radiation Therapy of Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Jan, Nuzhat; Guy, Christopher; Reshko, Leonid B; Hugo, Geoffrey D; Weiss, Elisabeth

    2017-07-01

    To investigate the hypothesis that positional and anatomic variations during radiation therapy induce changes in lung and heart volumes and associated radiation doses. In this longitudinal investigation, variations in lung and heart volumes and standard dose parameters of mean lung dose, lung V20Gy, mean heart dose, and heart V40Gy were analyzed on weekly 4-dimensional CT scans of 15 lung cancer patients during conventionally fractionated radiochemotherapy. Tumor, individual lung lobes, and heart were delineated on the mid-ventilation phase of weekly 4-dimensional CT scans. Lung lobes and heart were also contoured on individual breathing phases of pre-, mid-, and end-of-treatment scans. Planning dose was transferred to consecutive scans via rigid registration. Volume and dose variations were assessed relative to the initial planning scan. Interfraction lung volume variability relative to week 0 was twice as large as tidal volume variability (8.0% ± 5.3% vs 4.0% ± 3.3%, P=.003). Interfraction lung volume variation ranged between 0.8% and 17.1% for individual patient means. Lower lung lobes had larger volume variability compared with upper lobes (13.5% ± 8.1% vs 7.0% ± 5.0%, Pheart volume variation was 7.2% (range, 3.4%-12.6%). Average mean heart dose variation was 1.2 Gy (range, 0.1-3.0 Gy) and average heart V40Gy variation 1.4% (range, 0%-4.2%). Anatomic and positional variations during radiation therapy induce changes in radiation doses to lung and heart. Repeated lung and heart dose assessment will provide a better estimate of the actual delivered dose and will improve prediction models for normal tissue toxicity, if assessed in larger cohorts. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Lung Organogenesis

    Science.gov (United States)

    Warburton, David; El-Hashash, Ahmed; Carraro, Gianni; Tiozzo, Caterina; Sala, Frederic; Rogers, Orquidea; De Langhe, Stijn; Kemp, Paul J.; Riccardi, Daniela; Torday, John; Bellusci, Saverio; Shi, Wei; Lubkin, Sharon R; Jesudason, Edwin

    2011-01-01

    Developmental lung biology is a field that has the potential for significant human impact: lung disease at the extremes of age continues to cause major morbidity and mortality worldwide. Understanding how the lung develops holds the promise that investigators can use this knowledge to aid lung repair and regeneration. In the decade since the “molecular embryology” of the lung was first comprehensively reviewed, new challenges have emerged—and it is on these that we focus the current review. Firstly, there is a critical need to understand the progenitor cell biology of the lung in order to exploit the potential of stem cells for the treatment of lung disease. Secondly, the current familiar descriptions of lung morphogenesis governed by growth and transcription factors need to be elaborated upon with the reinclusion and reconsideration of other factors, such as mechanics, in lung growth. Thirdly, efforts to parse the finer detail of lung bud signaling may need to be combined with broader consideration of overarching mechanisms that may be therapeutically easier to target: in this arena, we advance the proposal that looking at the lung in general (and branching in particular) in terms of clocks may yield unexpected benefits. PMID:20691848

  19. IL-6、IL-8在不同潮气量单肺通气肺癌根治术中的表达%Effect of One-lung Ventilation of Different Tidal Volume on the Expressions of Interleukin-6 and Interleukin-8 in Lung Cancer Patients during Radical Operation

    Institute of Scientific and Technical Information of China (English)

    林飞; 潘灵辉; 钱卫; 黄宇; 杜学柯; 裴圣林

    2012-01-01

    目的 观察在肺癌根治术中不同潮气量(VT)的单肺通气(OLV)对血IL-6、IL-8表达的影响.方法 30例行肺癌根治术患者,用随机数字表法分为3组.行双腔支气管插管麻醉,术中单肺通气期间在保持分钟通气量不变的情况下,A组VT=10 ml/kg,呼吸频率(f)=12次/min,B组VT=8 ml/kg,f=15次/min,C组VT=6 ml/kg,f=20次/min.在OLV前(T1)、OLV后30 min(T2)、60 min(T3)、OLV结束前(T4)检测血IL-6、IL-8的表达.结果 3组在T2、T3、T4时点的IL-6、IL-8表达均明显高于T1(P<0.05),且随OLV时间延长而逐渐升高;OLV后随设定的潮气量减低,IL-6及IL-8表达逐渐降低; A组的IL-6、IL-8表达显著高于B、C组(P<0.05).结论 在单肺通气的肺癌根治术中,采用小潮气量的通气模式可减少肺内炎症反应.%Objective To study effect of one-lung ventilation( OLV ) of different tidal volume( VT ) on the expressions of serum interleukin-6( IL-6 ) and interleukin-8( IL-8 ) in lung cancer patients during radical operation. Methods Thirty lung cancer patients undergoing radical operation were enrolled in the study. All the patients received double-lumen endobronchial intubation anesthesia, and were randomly divided into three groups after one-lung ventilation during radical operation: Group A( VT = 10 ml/kg, respiratory frequency( f ) = 12/min ), Group B( VT = 8 ml/kg, f = 12/min ), Group C( VT =6 ml/kg,f = 12/min ). The expressions of serum IL-6,IL-8 were detected before OLV( T1 ),30 min after OLV ( T2 ),60 min after OLV ( T3 ),1 min before OLV ending( T4 ). Results Compared with T1 ,the expressions of IL-6,IL-8 on T2 ,T3 ,T4 significantly increased in three groups( P <0. 05 ),and the increase was in a time-dependent manner. The expressions of IL-6, IL-8 gradually decreased with VT reduction during OLV. The expressions of IL-6, IL-8 in Group A were significantly higher than those in Group B, C( P < 0. 05 ). Conclusion The ventilation mode of low tidal volume can reduce the pulmonary

  20. Lung function; Lungenfunktion

    Energy Technology Data Exchange (ETDEWEB)

    Sorichter, S. [Universitaetsklinikum Freiburg, Abteilung Pneumologie, Freiburg (Germany)

    2009-08-15

    The term lung function is often restricted to the assessment of volume time curves measured at the mouth. Spirometry includes the assessment of lung volumes which can be mobilised with the corresponding flow-volume curves. In addition, lung volumes that can not be mobilised, such as the residual volume, or only partially as FRC and TLC can be measured by body plethysmography combined with the determination of the airway resistance. Body plethysmography allows the correct positioning of forced breathing manoeuvres on the volume-axis, e.g. before and after pharmacotherapy. Adding the CO single breath transfer factor (T{sub LCO}), which includes the measurement of the ventilated lung volume using He, enables a clear diagnosis of different obstructive, restrictive or mixed ventilatory defects with and without trapped air. Tests of reversibility and provocation, as well as the assessment of inspiratory mouth pressures (PI{sub max}, P{sub 0.1}) help to classify the underlying disorder and to clarify treatment strategies. For further information and to complete the diagnostic of disturbances of the ventilation, diffusion and/or perfusion (capillar-)arterial bloodgases at rest and under physical strain sometimes amended by ergospirometry are recommended. Ideally, lung function measurements are amended by radiological and nuclear medicine techniques. (orig.) [German] Unter dem Begriff Lungenfunktion wird die Bestimmung der Lungenvolumina am Mund verstanden. Dabei werden die mobilisierbaren Lungenvolumina mit den zugehoerigen Fluss-Volumen-Kurven mittels Spirometrie und Ganzkoerperplethysmographie (GKP) und die nicht (RV) und teilweise mobilisierbaren Lungenvolumina (FRC, TLC) einschliesslich der Atemwegswiderstaende bestimmt. Die GKP ermoeglicht zusaetzlich die korrekte (Volumenachsen-)Positionierung der forcierten Atemmanoever. Dieses erlaubt eine uebersichtlichere graphische Darstellung z. B. vor und nach der Applikation pharmakologisch wirksamer Substanzen. Wird die GKP

  1. Late course shrinking gross tumor volume (GTV) and boost radiotherapy for a special left lung cancer patient whose right lung was resected: a case report%右肺全切患者左肺中心型肺癌后程缩野加量放疗后长期存活1例报道

    Institute of Scientific and Technical Information of China (English)

    Shaohui Cheng; Zhanzhao Fu; Tao Gu

    2012-01-01

    We reported a special case of a locally advanced squamous cell carcinoma of the left lung. Due to pulmonary tuberculosis, the patient had underwent a complete right-side pulmonary lobectomy 20 years ago. Left lung supports his life, he is unable to carry on an operation treatment, so he accepted radiotherapy. Firstly, we defined gross tumor volume (GTV1) by CT simulation location, three-dimensional conformal radiotherapy (3D-CRT) was used until tumor dose reached 50 Gy/25 f. Secondly, by repeating the planning CT scan, defined GTV2, continued to radiotherapy by 2.5 Gy/f until the dose was 65 Gy/31 f. Using the same method for third CT scan, defined GTV3, continued to radiotherapy by 3 Gy/f until the total dose was 74 Gy/34 f. After radiotherapy, the patient acquired complete response and he had no obvious side-effect of radiotherapy. There has been no recurrence for 5 years now.

  2. The Presence of Anti-p53 Antibodies in Sera Prior to Thoracic Surgery in Non Small Cell Lung Cancer Patients: Its Implications on Tumor Volume, Nodal Involvement, and Survival

    Directory of Open Access Journals (Sweden)

    Michael Bergqvist

    2003-07-01

    Full Text Available BACKGROUND: During recent years, a correlation between the presence of antibodies in sera against p53 and survival has been reported. The aim of the present study was to analyze anti-p53 antibodies in sera from patients with non small cell lung cancer (NSCLC prior to thoracic surgery and their correlation to survival, nodal involvement, and tumor volume. PATIENTS AND METHODS: Serum samples from 58 patients with NSCLC admitted to the Department of Pulmonary Medicine in Uppsala were collected between 1993 and 1995 and analyzed for the expression of anti-p53 antibodies. RESULTS: Antibodies against p53 were detected in 12 patients (21%. No association was found between increased levels of anti-p53 antibodies and tumor volume (P = .84. There was a numerical trend towards higher levels of anti-p53 antibodies in patients without nodal disease, when compared with patients with nodal involvement, although not statistically significant (P = .136. However, when patients with metastatic disease were included, statistically significantly lower levels of anti-p53 antibodies were demonstrated, in comparison to patients without any sign of nodal engagement or metastatic disease (P = .038. Anti-p53 antibodies and survival showed no correlation between increasing index levels of anti-p53 antibodies and survival (P = .18. Neither was a correlation found between using the cutoff (>1.1 described by the manufacturer and survival. CONCLUSION: The presence of anti-p53 antibodies was correlated neither to survival nor to tumor volume in the present study. However, patients with either nodal or metastatic disease had lower levels of anti-p53 antibodies in comparison to patients without signs of either nodal or metastatic disease. These issues are discussed.

  3. Open lung biopsy

    Science.gov (United States)

    ... CT scan Disseminated tuberculosis Granulomatosis with polyangiitis Lung cancer - small cell Lung disease Lung needle biopsy Malignant mesothelioma Pulmonary tuberculosis Rheumatoid lung disease Sarcoidosis Simple pulmonary eosinophilia ...

  4. Effect of lung protection strategy on stroke volume variation in patients undergoing open-chest operation%肺保护策略对胸外科手术患者每搏量变异度的影响

    Institute of Scientific and Technical Information of China (English)

    陆珠凤; 葛圣金; 薛张纲; 邓小明

    2012-01-01

    目的 探讨肺保护策略对择期行胸外科手术患者每搏量变异度(SVV)的影响.方法 选择20例择期行开胸手术的患者,ASA分级Ⅰ~Ⅱ级,均无术前用药.研究患者清醒平卧位自主呼吸(T1)、清醒侧卧位自主呼吸(T2)、单纯全麻平卧位双肺通气(T3)、单纯全麻平卧位肺保护策略下单肺通气(T4)、单纯全麻侧卧位双肺通气(T5)、单纯全麻侧卧位肺保护策略下单肺通气(T6)、联合麻醉肺保护策略下单肺通气切皮时(T7)以及联合麻醉肺保护策略下单肺通气切开胸膜时(T8)的心率(HR)、平均动脉压(MAP)、SVV、心脏指数(CI)4个血流动力学指标的变化,以及SVV变化与HR、MAP、CI的相关性.4个指标数据组内采用单因素方差分析,根据方差齐性检验结果决定进一步统计学检验方案,4个数据组间采用Pearson相关分析.结果 单因素方差分析结果显示,T1~T8时间点SVV、HR变化差异无统计学意义(P>0.05),MAP、CI的变化差异有统计学意义(P<0.05);方差齐性LSD多重比较结果显示,SVV在T2时间点与T5时间点之间,CI在T1时间点与T3~T8时间点之间,CI在T2时间点与T4时间点、T6~T8时间点之间,MAP在T1时间点与T3~T4时间点、T6~T8时间点之间,MAP在T2时间点与T3~T4时间点、T6~T8时间点之间,MAP在T4时间点与T5时间点之间差异有统计学意义(P<0.05).相关分析结果显示SVV与CI呈负相关(r=-0.267,P=0.018).结论 术前无容量不足的患者体位改变(从仰卧位到侧卧位)对SVV和HR无显著影响;肺保护策略下单肺通气对SVV、HR、MAP和CI均无显著影响;麻醉因素可引起MAP和CI明显下降,且麻醉状态下被动翻身动作可引起MAP和CI升高,SVV变化与CI呈负相关,但相关性较弱.%Objective To investigate the effect of lung-protective ventilation mode on stroke volume variation (SVV) in patients receiving selected thoracotomy. Methods Twenty patients of the American

  5. Interstitial lung disease

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930124 The effect of glycosaminoglycans inthe genesis of pulmonary interstitial fibrosis.LIBaoyu(李保玉),et al.Dept Pathol,Jilin MedColl,132001.Chin J Tuberc & Respir Dis 1992;15(4):204-205.The pulmonary interstitial fibrosis was causedby injecting Bleomycin into mouse trachea.Afterthe injection,the volume of glycosaminoglycans(GAG)in bronchoalveolar lavage fluid and lungtissues was increased.The observation underhistochemical stain and electron microscopeshowed that the distribution of GAG in lung tis-sues was varied at different time after the injec-tion,and related to the volume of collagen pro-teins and the formation of pulmonary interstitialfibrosis.

  6. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP).

    Science.gov (United States)

    Sato, Masaaki; Murayama, Tomonori; Nakajima, Jun

    2016-10-01

    Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide "geometric information" to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) "standing" stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V- or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones.

  7. Emphysema quantification on low-dose CT using percentage of low-attenuation volume and size distribution of low-attenuation lung regions: Effects of adaptive iterative dose reduction using 3D processing

    Energy Technology Data Exchange (ETDEWEB)

    Nishio, Mizuho, E-mail: nmizuho@med.kobe-u.ac.jp [Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Matsumoto, Sumiaki, E-mail: sumatsu@med.kobe-u.ac.jp [Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Seki, Shinichiro, E-mail: sshin@med.kobe-u.ac.jp [Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Koyama, Hisanobu, E-mail: hkoyama@med.kobe-u.ac.jp [Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Ohno, Yoshiharu, E-mail: yosirad@kobe-u.ac.jp [Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Fujisawa, Yasuko, E-mail: yasuko1.fujisawa@toshiba.co.jp [Toshiba Medical Systems Corporation, 1385 Shimoishigami, Otawara, Tochigi 324-8550 (Japan); Sugihara, Naoki, E-mail: naoki.sugihara@toshiba.co.jp [Toshiba Medical Systems Corporation, 1385 Shimoishigami, Otawara, Tochigi 324-8550 (Japan); and others

    2014-12-15

    Highlights: • Emphysema quantification (LAV% and D) was affected by image noise on low-dose CT. • For LAV% and D, AIDR 3D improved agreement of quantification on low-dose CT. • AIDR 3D has the potential to quantify emphysema accurately on low-dose CT. - Abstract: Purpose: To evaluate the effects of adaptive iterative dose reduction using 3D processing (AIDR 3D) for quantification of two measures of emphysema: percentage of low-attenuation volume (LAV%) and size distribution of low-attenuation lung regions. Method and materials: : Fifty-two patients who underwent standard-dose (SDCT) and low-dose CT (LDCT) were included. SDCT without AIDR 3D, LDCT without AIDR 3D, and LDCT with AIDR 3D were used for emphysema quantification. First, LAV% was computed at 10 thresholds from −990 to −900 HU. Next, at the same thresholds, linear regression on a log–log plot was used to compute the power law exponent (D) for the cumulative frequency-size distribution of low-attenuation lung regions. Bland–Altman analysis was used to assess whether AIDR 3D improved agreement between LDCT and SDCT for emphysema quantification of LAV% and D. Results: The mean relative differences in LAV% between LDCT without AIDR 3D and SDCT were 3.73%–88.18% and between LDCT with AIDR 3D and SDCT were −6.61% to 0.406%. The mean relative differences in D between LDCT without AIDR 3D and SDCT were 8.22%–19.11% and between LDCT with AIDR 3D and SDCT were 1.82%–4.79%. AIDR 3D improved agreement between LDCT and SDCT at thresholds from −930 to −990 HU for LAV% and at all thresholds for D. Conclusion: AIDR 3D improved the consistency between LDCT and SDCT for emphysema quantification of LAV% and D.

  8. Impact of 18FDG-PET/CT on biological target volume (BTV) definition for treatment planning for non-small cell lung cancer patients

    Science.gov (United States)

    Devic, Slobodan; Tomic, Nada; Faria, Sergio; Dean, Geoffrey; Lisbona, Robert; Parker, William; Kaufman, Chris; Podgorsak, Ervin B.

    2007-02-01

    This work represents our effort to test feasibility of FDG-based PET/CT on target volume delineation in radiotherapy treatment planning of NSCLC patients. Different methods have been developed to enable more precise target outlining using PET: Qualitative Visual Method, CTV=2.5 SUV units, linear SUV threshold function method, and CTV=40% Iso of Maximum Uptake Value. We are proposing reconstruction of three biological target volumes: necrotic BTV (same as PTV created by radiation oncologist using CT data), proliferating BTV (based on PET signal to background ratio 1:3) and hypoxic BTV (based on PET signal to background ratio of 1:19). Two IMRT plans were created and compared to the conventional treatment plan: "conservative" IMRT plan delivers 52.5 Gy to the necrotic BTV and 65 Gy to the hypoxic BTV; "radical" IMRT plan delivers 30 Gy to necrotic BTV, 52.5 Gy to proliferating BTV and 65 Gy to hypoxic BTV. Use of BTVs in IMRT plans is attractive because it increases dose to targets considered to need higher doses. It reduces considerably dose to heart and spinal cord, organs considered to limit dose escalation approaches in NSCLC treatment. "Conservative" IMRT approach can be understood as a PET/CT-based concomitant boost to the tumor expressing the highest FDG uptake. "Radical" plan implies deviation from the traditional uniform dose target coverage approach, with the intention of achieving better surrounding tissue sparing and ultimately allowing for dose escalation protocols relying on biologically based treatment planning.

  9. An approach to interstitial lung disease in India

    Directory of Open Access Journals (Sweden)

    J N Pande

    2014-07-01

    Full Text Available Interstitial lung diseases are common and have varied etiology, clinical presentation, clinical course and outcome. They pose a diagnostic challenge to physicians and pulmonologists. Patients present with dry cough, exertional dyspnoea, interstitial lesions on X-ray of the chest and restrictive ventilatory defect on spirometry. A sharp decline in oxygen saturation with exercise is characteristic. Careful evaluation of the history of the patient and physical examination help in narrowing down diagnostic probabilities. HRCT of the chest has emerged as an important tool in the evaluation of these disorders. Idiopathic Interstitial Pneumonias (IIP are a group of conditions which are classified into several types based on pathological features. Bronchoscopic procedures are helpful in diagnosis of certain disorders but are of limited value in classification of IIP which requires surgical biopsy. Usual Interstitial Pneumonia (UIP, also referred to as Idiopathic Pulmonary Fibrosis, has a progressive course and an unfavourable outcome. Certain new drugs have recently become available for treatment of UIP. Our approach towards diagnosis and management of interstitial lung diseases based on personal experience over the past three decades is reported here. Key words: Usual interstitial pneumonia – sarcoidosis – pneumoconiosis – bronchoscopy – lung biopsy 

  10. Impact of 18FDG-PET/CT on biological target volume (BTV) definition for treatment planning for non-small cell lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Devic, Slobodan [Medical Physics Department, McGill University Health Centre, Montreal, Que. (Canada)]. E-mail: devic@medphys.mcgill.ca; Tomic, Nada [Medical Physics Department, McGill University Health Centre, Montreal, Que. (Canada); Faria, Sergio [Radiation Oncology Department, McGill University Health Centre, Montreal, Que. (Canada); Dean, Geoffrey [Nuclear Medicine Department, McGill University Health Centre, Montreal, Que. (Canada); Lisbona, Robert [Nuclear Medicine Department, McGill University Health Centre, Montreal, Que. (Canada); Parker, William [Medical Physics Department, McGill University Health Centre, Montreal, Que. (Canada); Kaufman, Chris [Medical Physics Department, McGill University Health Centre, Montreal, Que. (Canada); Podgorsak, Ervin B. [Medical Physics Department, McGill University Health Centre, Montreal, Que. (Canada)

    2007-02-01

    This work represents our effort to test feasibility of FDG-based PET/CT on target volume delineation in radiotherapy treatment planning of NSCLC patients. Different methods have been developed to enable more precise target outlining using PET: Qualitative Visual Method, CTV=2.5 SUV units, linear SUV threshold function method, and CTV=40% Iso of Maximum Uptake Value. We are proposing reconstruction of three biological target volumes: necrotic BTV (same as PTV created by radiation oncologist using CT data), proliferating BTV (based on PET signal to background ratio 1:3) and hypoxic BTV (based on PET signal to background ratio of 1:19). Two IMRT plans were created and compared to the conventional treatment plan: 'conservative' IMRT plan delivers 52.5 Gy to the necrotic BTV and 65 Gy to the hypoxic BTV; 'radical' IMRT plan delivers 30 Gy to necrotic BTV, 52.5 Gy to proliferating BTV and 65 Gy to hypoxic BTV. Use of BTVs in IMRT plans is attractive because it increases dose to targets considered to need higher doses. It reduces considerably dose to heart and spinal cord, organs considered to limit dose escalation approaches in NSCLC treatment. 'Conservative' IMRT approach can be understood as a PET/CT-based concomitant boost to the tumor expressing the highest FDG uptake. 'Radical' plan implies deviation from the traditional uniform dose target coverage approach, with the intention of achieving better surrounding tissue sparing and ultimately allowing for dose escalation protocols relying on biologically based treatment planning.

  11. Changes of pulmonary function and quality of life in mid-term after lung volume reduction surgery%肺减容术后中期肺功能变化和生活质量评估

    Institute of Scientific and Technical Information of China (English)

    赵旭东; 石开虎; 吴君旭; 徐盛松

    2014-01-01

    Objective To observe the mid-term changes of pulmonary function and quality of life in the patients with emphysema who have undergone lung volume reduction surgery.Methods 44 subjects with severe emphysema underwent single or double lung volume reduction surgery through thoracoscope.There were 33 male and 11 female in the population analyzed with an age range of 46 to 70 years old.The mean age of the patients was (65.2-± 6.0) years.The pulmonary function and quality of life evaluation were determined over 3 time periods:prior to surgery,12 months postsurgery,and 24 months postsurgery Pulmonary function measurement project including the forced expiratory volume in 1 second (FEV 1),FEV 1% of predicted value,residual volume (RV),RV % of predicted value,partial pressure of oxygen(PO2),partial pressure of carbon dioxide (PCO2),life quality evaluation performed in the form of questionnaire,including whether under anhelation,satisfactory sleep,living by self-care,participating in household duties,taking part in social work,whether to have a good mental state and have a hobby.Results There was 1 death of 44 patients from respiratory failure.43 patients recovered smoothly.4 cases were lost to follow-up.In 39.patients with follow-up,1 patient succumbed to cerebrovascular at 13 months after surgery.The other 38 cases compared with the preoperative at 12 and 24 months postsurgery,postoperative forced expiratory volume in 1 second (FEV1) increased,P < 0.05,residual gas volume (RV) decreased,P < 0.05,partial pressure of oxygen (PO2) increased,P < 0.05,partial pressure of carbon dioxide (PCO2) decreased,P < 0.05,meanwhile,the quality of life has improved significantly.Conclusion Lung volume reduction surgery in patients with severe obstructive emphysema can improve pulmonary function and quality of life.And its effect would not disappeared in the short term.%目的 对接受肺减容手术的重度阻塞性肺气肿患者,进行术后肺功能中期随访,以

  12. Comparison of volume controlled with pressure comtrolled one-lung ventilation during thoracic surgery%胸科手术单肺通气期间定容模式和定压模式的比较

    Institute of Scientific and Technical Information of China (English)

    阳世光; 袁爱武

    2008-01-01

    Objective To compare the effects of volume controlled with pressure comtrolled one-lung ventilation during thoracic surgery. Methods Twenty-four ASA Ⅰ~Ⅱ patients ( 18 male ,6 female)aged 18~68 years old undergoing one-lung ventilation (OLV) thoracic surgery were randomly divided into 2 groups ( n = 12 cases). After general anesthesia induction was performed, each patient was inserted a double-lumen tube. Twolung ventilated with volume controlled ventilation (TLV-VCV) was carried out in the lateral decubitus position in all patients. In group Ⅰ, one-lung ventilation was started by volume controlled ventilation (OLV-VCV) for 30 minutes and ventilation mode was then swithched to pressure controlled ventilation (OLV-PCV). Ventilation modes were performed in the opposite order in group Ⅱ, one-lung ventilation was started by pressure controlled ventilation (OLV-PCV) for 30 minutes and ventilation mode was then swithched to volume controlled ventilation (OLV-VCV). The following variables were measured and recorded at the end of TLV-VCV and at 30 minutes of OLV-VCV or OLV-PCV. Heart rate (HR),mean arterial pressure (MAP) and pulse oxygen degree (SpO2) were measured by a same HP monitor. Central venous pressure (CVP) was measured by a special ruler. Tidal volume (VT), peak airway pressure (Ppeak) and mean airway pressure (Pmean) were measured by a same Datex-Ohmeda Aestiva/5 anesthesia machine. End-tide carbon dioxide pressure was measured by a monitor of anesthesia machine. Meantime arterial blood oxygen tsensions and saturations (PaO2, Sat2) and arterial blood carbon dioxide tsensions (PaCO2) were analysed by arterial venous blood gases. Results There were no significant differences in HR, MAP, CVP and SpO2 between TLV-VCV, OLV-VCV and OLV-VCV (P>0. 05). Ppeak and Pmean were significant higher during OLV-VCV or OLV-PCV than during TLV-VCV (P 0.05). Conclusion The effects of OLV-PCV was superior to OLV-VCV during thoracic surgery.%目的 比较胸科手术单

  13. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study.

    NARCIS (Netherlands)

    Vonk Noordegraaf, A.; Postmus, P.E.; Sutedja, G.

    2003-01-01

    or=1 cm in size, intraluminally located in the central airways, with no bronchial wall invasion or extraluminal tumor growth on high resolution CT (HRCT), with visible distal margin under conventional and autofluorescence bronchoscopy (AFB). BT was given with curative intent and consecutive patients

  14. Comparação entre o uso de bocal e máscara facial na avaliação de volumes pulmonares e capacidade vital em indivíduos saudáveis Comparison between the use of mouthpiece and facemask in assessing lung volumes and vital capacity in healthy subjects

    Directory of Open Access Journals (Sweden)

    Patrícia Fregadolli

    2010-03-01

    Full Text Available Testes de função pulmonar são usados para determinar a gravidade, as conseqüências funcionais e o progresso de disfunções pulmonares e neuromusculares. As variações metodológicas com o bocal e a máscara facial e a cooperação do paciente podem interferir no desempenho das manobras e afetar as medidas. O objetivo deste estudo foi comparar os valores de volumes pulmonares (volume corrente [Vc], volume-minuto [Vm], freqüência respiratória (FR e capacidade vital (CV em indivíduos saudáveis quando avaliados por meio do bocal e da máscara facial. Participaram do estudo 60 voluntários saudáveis, 14 homens e 46 mulheres, com média de idade de 22,9±7,1 anos. Para a avaliação com bocal, utilizou-se uma peça semirrígida descartável e clipe nasal; a máscara usada foi facial plástica com borda pneumática inflável. As medidas obtidas foram comparadas estatisticamente (nível de significância 5%. Os valores obtidos com o bocal e com a máscara facial foram, respectivamente: FR, 15 rpm x 13 rpm (pRespiratory function tests are used to determinate severity, functional consequences and progress of pulmonary and neuromotor dysfunctions. Methodological variations - by means of a mouthpiece or a facemask - and patient's cooperation may interfere in manoeuvre performance and affect measures. The aim of this study was to compare lung volume values (tidal volume [VT] and minute volume [Vm], respiratory rate (RR, and vital capacity (VC in healthy individuals when assessed by using a mouthpiece and a facemask. A total of 60 healthy subjects (14 men and 46 women, mean aged 22.86±7.14 years, were evaluated. Items used were a disposable, semi-rigid mouthpiece, with a nose clip, and a plastic facemask with pneumatic inflatable sealing. Measures obtained were statistically compared, with significance level set at 5%. Mean values obtained with the mouthpiece and the facemask were, respectively: RR, 15 rpm x 13 rpm (p<0.01; Vm, 14.87 l/min x 10

  15. Lung Cancer

    Science.gov (United States)

    Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and ...

  16. Lung Diseases

    Science.gov (United States)

    When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to ... you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in ...

  17. Lung transplantation

    Science.gov (United States)

    Afonso, José Eduardo; Werebe, Eduardo de Campos; Carraro, Rafael Medeiros; Teixeira, Ricardo Henrique de Oliveira Braga; Fernandes, Lucas Matos; Abdalla, Luis Gustavo; Samano, Marcos Naoyuki; Pêgo-Fernandes, Paulo Manuel

    2015-01-01

    ABSTRACT Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life supp