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Sample records for severe subcutaneous emphysema

  1. A case of severe subcutaneous emphysema in the post-operative period following cleft lip surgery

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    B Vijayakumar

    2010-01-01

    Full Text Available Subcutaneous emphysema is not an unknown complication following cleft lip surgery. We describe a case of severe subcutaneous emphysema that developed six hours after surgery. The laryngoscopic intubation was smooth. Following subcutaneous emphysema the patient was treated conservatively with mask oxygen and spontaneous resolution occurred within 48 hours.

  2. [Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].

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    Ideno, Satoshi; Miyazawa, Noriko; Ishikawa, Saki; Wakamiya, Rie; Shinto, Atsushi; Mikasa, Hiromi; Yamamoto, Shinichi

    2014-06-01

    A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. Following the American Society of Anesthesiologist (ASA) guidelines for management of difficult airway, we prepared various types of equipment to facilitate intubation and surgeons were beside the patient during induction of anesthesia for emergency invasive airway access. To prevent the progression of emphysema, preservation of spontaneous breathing during the perioperative period was also important. Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.

  3. Massive subcutaneous emphysema with pneumoscrotopenis ...

    African Journals Online (AJOL)

    Chest injury commonly leads to subcutaneous emphysema of the chest, neck and face. It is usually non-life threatening. Massive subcutaneous emphysema may occur and very rarely may spread to involve the scrotal sac and subcutaneous tissue planes of the penis to cause pneumoscrotopenis. This case report presents ...

  4. [Measles and subcutaneous emphysema. Presentation of 3 cases].

    Science.gov (United States)

    Montesano-Delfín, J R; Mascareñas-Ponce, A

    1991-03-01

    This is a three case study report of children with measles which later progressed to bronchopneumonia and subcutaneous emphysema. All three children were from farming families, and none had been previously vaccinate against measles. For a period of six months, 183 cases of measles were treated at our hospital of which only three worsened to subcutaneous emphysema, demonstrating an incidence rate of 1.6%; they also showed to have bronchopneumonia, with severe coughing episodes; which made us recall the possible physiopathology principle of the pressure gradient theory behind this complication proposed by Bloch in 1968. The factors related to our patients suggested a more severe and aggresive type of measles with a greater probability of having complications. The prognostic value of the severity of this type of measles in the presence of subcutaneous emphysema is limited and its management should be primarly focused on treating the added bronchial problem.

  5. Subcutaneous emphysema in cavitary pulmonary tuberculosis without pneumothorax or pneumomediastinum

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    Ramakant Dixit

    2012-01-01

    Full Text Available Extra-alveolar air in the form of subcutaneous tissue emphysema is observed in a variety of clinical settings. Spontaneous subcutaneous emphysema in the absence of pneumothorax or pneumomediastinum is very rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax or pneumomediastinum.

  6. Case Report Pneumomediastinum and Subcutaneous Emphysema ...

    African Journals Online (AJOL)

    oxygen may enhance faster absorption of air from extra-pulmonary tissues while needle aspiration and/ or surgical decompression may be useful if mediastinal structures are compressed [2,9,]. Conclusion. Extra-pulmonary extravasations of air manifested as subcutaneous emphysema and pneumomediastinum.

  7. Recurrent subcutaneous emphysema of the face: a challenging clinical problem.

    Science.gov (United States)

    Hojjati, Hossein; Davani, Sam Zeraatian Nejad; Johari, Hamed Ghoddusi

    2007-01-01

    In the neck or face, there are different causes for subcutaneous emphysema such as injury to the sinuses, the hypopharynx, the laryngotracheal complex, the pulmonary parenchyma, the esophagus or the presence of gas-forming organisms. However, factitious subcutaneous emphysema, a rare cause, must be considered in the differential diagnosis. In this clinical report, we discuss a 20-year-old girl who was under follow-up because of recurrent subcutaneous emphysema of the face and periorbital area. After 2 years of work-ups, including a period of close observation in the intensive care unit, self air injection by syringe was found as the cause of recurrent subcutaneous emphysema of the face, and the patient was labeled as having factitious recurrent subcutaneous emphysema. Therefore, when a patient presents with unexplained recurrent subcutaneous emphysema, one should suspect self-infliction and examine for puncture marks.

  8. A Case of Amyopathic Dermatomyositis with Pneumomediastinum and Subcutaneous Emphysema

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    Aslıhan Gürün Kaya

    2015-01-01

    Full Text Available A 34-year-old man was admitted with dyspnea, cough, and fever. Thorax computed tomography revealed ground glass opacities and pneumomediastinum. The patient was diagnosed as amyopathic dermatomyositis due to skin lesions and radiological findings. Despite immunosuppressive treatment clinical deterioration and radiological progression were observed and the patient died because of severe hypoxemic respiratory failure. The patient presented with extremely rare occurrence of pneumomediastinum and subcutaneous emphysema in amyopathic dermatomyositis with a poor prognosis.

  9. Management of extensive surgical emphysema with subcutaneous drain: A case report

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    Quoc Tran

    Full Text Available Introduction: Subcutaneous emphysema (SE is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, “tension phenomenon” and respiratory failure require treatment. Presentation of case: A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest drain. Immediate improvement was observed after insertion of a large-bore, 26 French (Fr. intercostal catheter, subcutaneous drain which was maintained under low suction (−5 cm H2O for a further 24 h. Discussion: Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular “blow holes” incisions and subcutaneous drains or simply increasing suction on an in situ chest drain. Here a large-bore, fenestrated, subcutaneous drain maintained on low negative pressure also provided the necessary decompression. Conclusion: In the absence of a comparative study to identify the most effective method to manage extensive subcutaneous emphysema, this case highlights an effective, simple and safe management option. Keywords: Pneumothorax, Subcutaneous emphysema, Drain, Low suction, Intercostal catheter, Case report

  10. Cervicofacial subcutaneous emphysema associated with dental laser treatment.

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    Mitsunaga, S; Iwai, T; Kitajima, H; Yajima, Y; Ohya, T; Hirota, M; Mitsudo, K; Aoki, N; Yamashita, Y; Omura, S; Tohnai, I

    2013-12-01

    Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment. Emphysema as a complication caused by the air cooling spray of a dental laser is not well known, even though dental lasers utilize compressed air just as air turbines and syringes do. In this study, we comprehensively reviewed cases of emphysema attributed to dental laser treatment that appeared in the literature between January 2001 and September 2012, and we included three such cases referred to us. Among 13 cases identified in total, nine had cervicofacial subcutaneous and mediastinal emphysema. Compared with past reviews, the incidence of mediastinal emphysema caused by dental laser treatment was higher than emphysema caused by dental procedure without dental laser use. Eight patients underwent CO2 laser treatment and two underwent Er:YAG laser treatment. Nine patients had emphysema following laser irradiation for soft tissue incision. Dentists and oral surgeons should be cognizant of the potential risk for iatrogenic emphysema caused by the air cooling spray during dental laser treatment and ensure proper usage of lasers. © 2013 Australian Dental Association.

  11. Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

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    Mehdi Bakhsaee

    2017-03-01

    Full Text Available Introduction:Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM and polymyositis (PM, both of which can be fatal. Case Report:A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died. Conclusion:During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.

  12. Subcutaneous emphysema as a complication of tooth extraction

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    Vacić Aca

    2004-01-01

    Full Text Available Subcutaneous emphysema is a rare complication in dentistry, which may lead to diagnostic errors and inadequate therapy. A 17 years old female patient, in whom the separation of tooth roots was performed by the use of air-powered drill during the extraction of the first right lower molar, is presented in this paper. During the intervention, swelling of the right half of the face and the lower eyelid suddenly occurred, accompanied with simultaneous feeling of choking, and pressure in the neck and chest. Because of the suspicion of the allergic reaction, the patient was administered antihistaminic agent, together with parenteral corticosteroid, and was sent to an institution where she was treated as an in-patient. During hospitalization, subcutaneous emphysema of the face and neck was diagnosed by physical and x-ray examination. The emphysema completely disappeared after the use of oxygen and antibiotics.

  13. Subcutaneous face and neck surgical emphysema secondary to ...

    African Journals Online (AJOL)

    Subcutaneous face and neck surgical emphysema secondary to presumed spider bite. W Mulwafu. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  14. Pneumoperitoneum with Subcutaneous Emphysema after Percutaneous Endoscopic Gastrostomy

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    Yalin Iscan

    2014-01-01

    Full Text Available Percutaneous endoscopic gastrostomy is a safe way for enteral nutrition in selected patients. Generally, complications of this procedure are very rare but due to patients general health condition, delayed diagnosis and treatment of complications can be life threatening. In this study, we present a PEG-related massive pneumoperitoneum and subcutaneous emphysema in a patient with neuro-Behçet.

  15. Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia.

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    Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung; Kwon, Young Joo

    2011-06-01

    30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

  16. Pneumomediastinum and subcutaneous emphysema in a cat associated with necrotizing bronchopneumonia caused by feline herpesvirus-1.

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    Maes, Sofie; Van Goethem, Bart; Saunders, Jimmy; Binst, Dominique; Chiers, Koen; Ducatelle, Richard

    2011-10-01

    This report describes a 1-year-old cat with acute dyspnea. Thoracic radiography revealed a pneumomediastinum and severe subcutaneous emphysema. Lower airway surgical exploration was unable to determine the cause. At postmortem examination, acute necrotizing bronchopneumonia and fibrinonecrotic tracheitis due to feline herpesvirus-1 were diagnosed.

  17. Massive subcutaneous emphysema after carbon dioxide mesotherapy.

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    Calonge, Wenceslao M; Lesbros-Pantoflickova, Drahoslava; Hodina, Marina; Elias, Badwi

    2013-02-01

    The authors report the observation of a 43-year-old woman with severe pain on her right upper abdominal quadrant. Differential diagnoses included acute cholecystitis, spontaneous pneumothorax, perforated appendicitis and a recidive of renal calculus. CT-scan showed a huge subdermal gas bubble along her right flank and anterior abdominal wall up to the submammary fold. Only at this point, the patient admitted to have undergone a carboxytherapy procedure on both thighs one day before onset of pain in a paramedical facility. As some of the injection trajects were still patent on CT-scan, she received prophylactic antibiotic coverage. Though there was a complete resorption of gas after 10 days, dysesthesias and muscle contracture persisted for 3 weeks. To the authors' knowledge this migration and coalescence of injected gas in a single bubble has not been previously reported. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  18. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

    LENUS (Irish Health Repository)

    Browne, J

    2012-02-03

    PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient\\'s trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: Pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.

  19. A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema in Children

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    Said Benlamkaddem

    2018-02-01

    Full Text Available Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum, which almost invariably originates from the alveolar space or the conducting airways. It is rare in pediatric patients; however, occasional cases are reported to result from forced Valsalva’s maneuver due to cough, emesis, a first attack of wheeze, or asthma exacerbations. We report the case of a 7-year-old previously healthy girl, with a history of persistent dry cough one day before, who was brought to our unit with face, neck and chest swelling. The chest X-ray and computed tomography (CT scan showed subcutaneous emphysema with pneumomediastinum and pneumopericardium without evidence of the origin of this air leak. Laboratory tests and the bronchoscopy were normal. The patient was admitted in the pediatric critical care and received noninvasive monitoring, analgesia, oxygen, and omeprazole as a prophylaxis for a gastric ulcer. The patient improved, subcutaneous emphysema resolved, and she was discharged on the third day.

  20. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

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    S. Fosi

    2014-01-01

    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  1. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

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    Monica Hagan Vetter

    2015-01-01

    Full Text Available Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.

  2. Spontaneous subcutaneous emphysema of the scalp following hair coloring/treatment

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    Sanjit O. Tewari, MD

    2017-03-01

    Full Text Available Subcutaneous emphysema of the scalp is a process often attributed to secondary factors such as trauma, infection, or a myriad of iatrogenic etiologies. Here, we are presenting a case report of an adult patient with spontaneous subcutaneous emphysema of the scalp following a hair coloring/treatment. We performed an extensive review of literature on this topic, however, could not find a single case with similar presentation of subcutaneous emphysema. This case demonstrates an unreported etiology for this diagnosis and is thus being reported for its uniqueness and to raise clinical awareness.

  3. Enfisema subcutâneo maciço - Tratamento com drenos subcutâneos Massive subcutaneous emphysema - Management using subcutaneous drains

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    Maria Sucena

    2010-04-01

    Full Text Available O enfisema subcutâneo é uma complicação relativamente comum na sequência de técnicas invasivas, procedimentos cirúrgicos e algumas patologias médicas. Na maior parte dos casos apenas causa sintomatologia minor e o tratamento é habitualmente conservador. Mesmo quando grave, raramente tem consequências patofisiológicas significativas, apesar de ser extremamente desconfortável para o doente. Os autores descrevem um caso clínico de enfisema subcutâneo maciço, de rápida instalação, após saída acidental de tubo de drenagem torácica, em doente com pneumotórax espontâneo secundário e fístula broncopleural. O enfisema foi tratado através da colocação, sob anestesia local, de dois drenos subcutâneos na parede anterossuperior do tórax, conectados a sacos de drenagem. Após a colocação dos drenos subcutâneos verificou-se uma franca melhoria clínica do doente, com descompressão eficaz do enfisema subcutâneo. No presente caso clínico, a técnica de drenagem do enfisema maciço mostrou-se simples, segura e eficaz, permitindo o alívio sintomático imediato.Massive subcutaneous emphysema is a relatively common complication in invasive techniques, surgical practice and some medical conditions. Subcutaneous emphysema is usually treated conservatively and may only cause minimal symptoms. Even when it is severe, subcutaneous emphysema rarely has pathophysiologic consequences, but it is extremely uncomfortable for the patient. The authors report a case of massive and rapid developing subcutaneous emphysema following chest tube displacement in a patient with spontaneous secondary pneumothorax and large air leak. The emphysema was treated with two subcutaneous drains, inserted using local anesthesia, on both sides of the chest (antero-superior thoracic wall, connected to drainage bags. The drains produced a dramatic clinical improvement and provided effective decompression of the subcutaneous emphysema. In this clinical case, the

  4. Subcutaneous emphysema of the upper extremity following penetrating blackthorn injury to the wrist.

    LENUS (Irish Health Repository)

    Tiong, W H C

    2009-02-01

    SUMMARY: Noninfective subcutaneous emphysema of the upper extremity, albeit rare, has to be borne in mind when treating patients with subcutaneous emphysema. The misdiagnosis of this condition as its serious infective counterpart often leads to unnecessary aggressive treatment. Noninfective subcutaneous emphysema often accompanies a patient who has no systemic symptoms of illness. Unfortunately, the distinction is not always easy especially when history of injury suggests involvement of an infective or reactive element. Penetrating blackthorn injury is common, especially in rural communities, and often occurs from farming or gardening activities. Blackthorn penetration can cause numerous tissue reactions once embedded under the skin and they are often contaminated with soil. Here we present, for the first time, a case where penetrating blackthorn injury to the wrist resulted in noninfective subcutaneous emphysema involving the whole upper limb and neck, and its subsequent management.

  5. Medical image of the week: bilateral pneumothorax, pneumomediastinum, and massive subcutaneous emphysema

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    Ahmed Z

    2014-03-01

    Full Text Available No abstract available. Article truncated at 150 words. An 80 year old man with chronic obstructive pulmonary disease (COPD presented to the emergency department with respiratory distress and poor oxygen saturation. Physical exam revealed an obese male in respiratory distress with poor air entry bilaterally and scattered wheezing. His chest, neck, tongue, and lips were swollen. The patient was intubated for respiratory failure, felt to be due to angioedema. His oxygen saturation immediately improved, however the patient developed progressive swelling throughout his body including his eyelids, fingers and toes. Diffuse crepitus was felt on palpation. Chest radiography and computed tomography (CT of the chest revealed large bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema (Figure 1. Bilateral chest tubes were inserted with re-expansion of both lungs. Over the next several days his respiratory parameters improved, with full re-expansion of the lungs and reabsorption of the pneumomediastinum and subcutaneous emphysema. The patient was extubated successfully and was discharged in good health. ...

  6. Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring.

    Science.gov (United States)

    Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

    2016-11-01

    The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods.This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe.The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01-3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48-4.15, P lung cancer development.In emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema.

  7. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

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    Narjis AL Saif

    2015-01-01

    Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  8. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube.

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    Al Saif, Narjis; Hammodi, Adel; Al-Azem, M Ali; Al-Hubail, Rasheed

    2015-01-01

    Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  9. Subcutaneous Emphysema in a Healthy Child: An Unusual Clue for the Diagnosis of Foreign Body Aspiration

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    Seied Mohsen Emami

    2017-09-01

    Full Text Available Background: Spontaneous pneumomediastinum (SPM and subcutaneous emphysema are rare findings in children. Various etiologies have been reported for SPM, such as foreign body aspiration in infants, especially in those aged less than three years. In addition to the complications associated with foreign body aspiration, SPM may also become a life-threatening condition if left untreated. In the present report, we discussed a case of subcutaneous emphysema, pneumothorax, and pneumomediastinum in a 13-month-old infant previously treated for pneumonia.Case report: The infant was initially presented with subcutaneous emphysema of the neck, without respiratory distress following pneumonia. In the chest radiography, mediastinal shift and possible pneumothorax were reported, and a chest tube was inserted as the respiratory condition deteriorated. Emergency bronchoscopy showed a foreign body logged in the left respiratory tract, which was removed. Three days later, the chest tube was detached, and the patient was discharged in healthy conditions within the next two days.Conclusion: Pediatricians constantly need to consider the risk of foreign body aspiration, particularly in the presence of respiratory complications, such as SPM, even in the infants with an unreliable history of foreign body aspiration

  10. Subcutaneous Emphysema in Non-Necrotizing Soft Tissue Injury

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    Hamid Ehsani-Nia

    2017-09-01

    Full Text Available History of present illness: 63-year-old male with a history of diabetes mellitus and rheumatoid arthritis who was sent to the emergency department by his primary care provider for further evaluation of left upper extremity crepitus. The patient fell onto his left elbow two days prior to presentation resulting in immediate swelling and a small laceration. He complained of minimal pain and denied fevers or chills. His medications included metformin, tocilizumab, methotrexate and prednisone. In the ED, the patient was well-appearing, afebrile, with a normal heart rate and in no acute distress. Examination of the left upper extremity revealed no tenderness to palpation but marked crepitus with a scabbed laceration over his olecranon process and was neurovascularly intact. White blood cell count (WBC, sodium, glucose, inflammatory markers and lactate were all within normal limits. Significant findings: X-Rays of the elbow revealed diffuse striated lucencies throughout the soft tissue, consistent with extensive subcutaneous air throughout the superficial and deep tissues. There was no evidence of a fracture. Discussion: The initiating mechanism for necrotizing soft tissue infections (NSTIs is a disruption of the fascial planes, most commonly by trauma. The inoculated bacteria rapidly spread and surgical debridement is necessary.1-3 Early recognition and disposition to the operating room in 51 are correlated with increased morbidity and mortality.5 Additionally, it has been found that immunocompromised patients exhibit atypical presentations of NSTIs.6 The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is often used to risk stratify patients when there is suspicion for an NSTI.7 The patient discussed here had a LRINEC score of 0. However, the physical exam finding of crepitus, coupled with his history of immunocompromised status and subcutaneous air on X-ray made the diagnosis of NSTI seem likely. However, upon surgical exploration

  11. Subcutaneous Emphysema Induced by Cryotherapy: A Complication due to Previous Punctures

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    Jared Martínez-Coronado

    2015-01-01

    Full Text Available Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse effects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy after multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved after expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be first administered or a cotton-tip applicator should be used.

  12. Subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumoperitoneum, and pneumoretroperitoneum by insufflation of compressed air at the external genitalia in a child.

    Science.gov (United States)

    Muramori, Katsumi; Takahashi, Yukiko; Handa, Noritoshi; Aikawa, Hisayuki

    2009-04-01

    A 7-year-old girl with concurrent subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumoperitoneum, and pneumoretroperitoneum arrived at our facility. Compressed air at 5 atm of pressure was insufflated through the nozzle of a spray gun over her external genitalia. She was admitted for a small amount of genital bleeding and significant subcutaneous emphysema extending from the cheek to the upper body. Radiographic examination of the abdomen was suggestive of a visceral perforation, but she was managed conservatively and discharged in satisfactory condition without surgical intervention. The female genitalia possibly served as the entry point for air into the retroperitoneum and peritoneal cavity, with subsequent migration of air through the esophageal hiatus that resulted in pneumomediastinum, pneumothorax, and extensive subcutaneous emphysema.

  13. Subcutaneous emphysema

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2016:chap 84. Eckstein M, Henderson SO. Thoracic trauma. In: Marx JA, Hockberger RS, ... by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by ...

  14. Relationship between regional severity of emphysema and coronary heart disease

    International Nuclear Information System (INIS)

    Nagao, Michinobu; Sakai, Shinya; Yasuhara, Yoshifumi; Ikezoe, Junpei; Murase, Kenya; Ichiki, Taku

    2000-01-01

    We analyzed the relationship between regional severity of emphysema, which was evaluated by three-dimensional fractal analysis (3D-FA) of Technegas SPECT images, and coronary heart disease (CHD). For 22 patients with emphysema who underwent Technegas SPECT, we followed up CHD events. The follow-up period was 5.4±0.5 (mean ±SD) years. We defined the upper-lung fractal dimension (U-FD) and lower-lung fractal dimension (L-FD) obtained with 3D-FA of Technegas SPECT images as the regional severity of emphysema. FD became greater with the progression of emphysematous change. During the follow-up period, CHD events occurred in 6 (27%) of the 22 patients. The ratio of U-FD to L-FD for patients with CHD events (0.87±0.22) was significantly smaller than for patients without CHD events (1.52±0.38) (p=0.0015). These findings suggest that severer emphysema in the lower lung indicates a higher risk of CHD than that in the upper lung. (author)

  15. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Maximilian Andreas Storz

    2017-01-01

    Full Text Available Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT demonstrated right-sided costal fractures (ribs 7 to 9, with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment.

  16. An Unusual Complication After the Extraction of a Maxillary Third Molar: Extensive Subcutaneous Emphysema. A Case Report

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    Emrah Soylu

    2016-09-01

    Full Text Available Third molar surgery is one of the most frequently performed procedures in oral and maxillofacial surgery. Various complications including pain, bleeding, infection, edema, hematoma, perforation of the maxillary sinus, and subcutaneous emphysema (SE can occur after third molar surgery. Cervicofacial subcutaneous emphysema (CSE most often occurs after the extraction of third molars, especially when using high-speed air-turbine drills and air syringes, or during dental laser treatment or even after endodontic treatment. This report presents the diagnosis and treatment protocol of a CSE in a 42-year-old healthy male patient that occurred after extraction of a totally erupted upper third molar with just a straight elevator and extraction forceps.

  17. [Unusual cutaneous emphysema in a newborn infant following bilateral pneumothorax].

    Science.gov (United States)

    Frisch, H; Luz, O; Pastner, E

    1985-01-01

    We report a patient with subcutaneous emphysema after a bilateral pneumothorax of gigantic extent: Subcutaneous emphysema extended over the chest, neck, axilla and both arms. The scalp was severed from the galea by an enormous air-cushion. Theories about the pathogenetic mechanisms are discussed. Therapy consisted of treatment of the underlying condition e. g. thoracocentesis with pleural drainage and artificial ventilation. The subcutaneous emphysema resolved without further therapeutic measures; only the subgaleal air was removed by aspiration.

  18. Orbital, mediastinal, and cervicofacial subcutaneous emphysema after endodontic retreatment of a mandibular premolar: a case report.

    Science.gov (United States)

    An, Gregory K; Zats, Boris; Kunin, Marc

    2014-06-01

    Subcutaneous emphysema (SCE) rarely occurs from endodontic treatment. Most reported cases of iatrogenic SCE occur in the cervicofacial region. Only a few cases have been reported of SCE extending into the mediastinum or orbital spaces. In the present report, we describe a concomitant occurrence of orbital, mediastinal, and cervicofacial SCE immediately after endodontic retreatment. A 33-year-old woman presented to the hospital with acute swelling of the right side of her face and neck. Earlier in the day, she began experiencing rapid swelling while undergoing endodontic retreatment of a mandibular right first premolar by her general dentist. The dentist immediately referred the case to an oral surgeon who then ordered additional tests and radiographic studies at the hospital. From there, the patient received consultation and comprehensive treatment by a multidisciplinary team of medical and dental staff. Physical examination, laboratory tests, and computed tomographic studies confirmed a diagnosis of SCE. Extensive air pockets were detected within the orbital, mediastinum, and cervicofacial spaces. The patient was admitted to the hospital and underwent treatment and observation for massive SCE with likely secondary infection. On the fifth day, she was discharged after showing dramatic improvement. SCE may go undetected or misdiagnosed. Complications may be fatal. Therefore, clinicians should apply preventive measures and know how to identify and manage SCE. We review reports of SCE in the last century, discuss etiology and differential diagnosis, and present recommendations for prevention and management of SCE. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. [Lung volume reduction surgery for severe pulmonary emphysema in Iceland].

    Science.gov (United States)

    Gunnarsson, Sverrir I; Johannsson, Kristinn B; Guðjónsdóttir, Marta; Jónsson, Steinn; Beck, Hans J; Magnusson, Bjorn; Gudbjartsson, Tomas

    2011-12-01

    Lung volume reduction surgery (LVRS) can benefit patients with severe emphysema. The aim of this study was to evaluate the outcome of LVRS performed in Iceland. A prospective study of 16 consecutive patients who underwent bilateral LVRS through median sternotomy between January 1996 and December 2008. All patients had disabling dyspnea, lung hyperinflation, and emphysema with upper lobe predominance. Preoperatively all patients underwent pulmonary rehabilitation. Spirometry, lung volumes, arterial blood gases and exercise capacity were measured before and after surgery. Mean follow-up time was 8.7 years. Mean age was 59.2 ± 5.9 years. All patients had a history of heavy smoking. There was no perioperative mortality and survival was 100%, 93%, and 63% at 1, 5, and 10 years, respectively. The forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC) improved significantly after surgery by 35% (plung capacity, residual volume and partial pressure of CO2 also showed statistically significant improvements but exercise capacity, O2 consumption and diffusing capacity of the lung for CO did not change. Prolonged air leak (≥ 7 days) was the most common complication (n=7). Five patients required reoperation, most commonly for sternal dehiscence (n=4). In this small prospective study, FEV1 and FVC increased and lung volumes and PaCO2 improved after LVRS. Long term survival was satisfactory although complications such as reoperations for sternal dehiscence were common and hospital stay therefore often prolonged.

  20. Facial Oedema Is Not Always Angioedema: A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema during COPD Exacerbation

    Directory of Open Access Journals (Sweden)

    Sarah Damanti

    2015-10-01

    Full Text Available We report a case of acute facial oedema in an elderly hospitalized patient which was initially misdiagnosed as angioedema secondary to antibiotics in a patient with an allergic diathesis. We describe the differential aetiologies and then the true cause of the oedema, which was an uncommon complication of a very common condition in the elderly: a pneumomediastinum with subcutaneous emphysema probably due to rupture of an emphysematous lung bulla during chronic obstructive pulmonary disease (COPD exacerbation. Lastly, we focus on the therapeutic procedures instituted for the treatment of the pneumomediastinum.

  1. Extensive Subcutaneous Emphysema After Extraction of a Mandibular Third Molar: A Case Report

    Directory of Open Access Journals (Sweden)

    Jung-Chang Kung

    2009-10-01

    Full Text Available Surgical emphysema is an uncommon but potentially serious complication of third molar removal and other oral procedures. The purpose of this case report is to remind dentists of the risk of surgical emphysema. Surgical emphysema developed in a 32-year-old female after removal of a mandibular third molar using a high-speed dental hand-piece. Because of the extent of the swelling, the patient was admitted for observation. Because of progressive swelling, a submandibular surgical incision and drainage was performed, which led to rapid resolution. The diagnosis and differential diagnosis of surgical emphysema are discussed to draw dentists' attention to the management and prevention of this complication.

  2. A peculiar blow-out fracture of the inferior orbital wall complicated by extensive subcutaneous emphysema: A case report and review of the literature.

    Science.gov (United States)

    Rzymska-Grala, Iwona; Palczewski, Piotr; Błaż, Marcin; Zmorzyński, Michał; Gołębiowski, Marek; Wanyura, Hubert

    2012-04-01

    Blow-out fracture of the orbit is a common injury. However, not many cases are associated with massive subcutaneous emphysema. Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting. The authors present a case of blow-out fracture complicated by extensive subcutaneous and mediastinal emphysema that occurred without any obvious traumatic event. A 43-year-old man presented to the Emergency Department with a painful right-sided exophthalmos that he had noticed in the morning immediately after waking up. The patient also complained of diplopia. Physical examination revealed exophthalmos and crepitations suggestive of subcutaneous emphysema. The eye movements, especially upward gaze, were impaired. CT showed blow-out fracture of the inferior orbital wall with a herniation of the orbital soft tissues into the maxillary sinus. There was an extensive subcutaneous emphysema in the head and neck going down to the mediastinum. The patient did not remember any significant trauma to the head that could explain the above mentioned findings. At surgery, an inferior orbital wall fracture with a bony defect of 3×2 centimeter was found and repaired. Blow-out fractures of the orbit are usually a result of a direct trauma caused by an object with a diameter exceeding the bony margins of the orbit. In 50% of cases, they are complicated by orbital emphysema and in 4% of cases by herniation of orbital soft tissues into paranasal sinuses. The occurrence of orbital emphysema without trauma is unusual. In some cases it seems to be related to barotrauma due to a rapid increase in pressure in the upper airways during sneezing, coughing, or vomiting, which very rarely leads to orbital wall fracture. Computed tomography is the most accurate method in detecting and assessing the extent of orbital wall fractures.

  3. Cluster analysis in severe emphysema subjects using phenotype and genotype data: an exploratory investigation

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    Martinez Fernando J

    2010-03-01

    Full Text Available Abstract Background Numerous studies have demonstrated associations between genetic markers and COPD, but results have been inconsistent. One reason may be heterogeneity in disease definition. Unsupervised learning approaches may assist in understanding disease heterogeneity. Methods We selected 31 phenotypic variables and 12 SNPs from five candidate genes in 308 subjects in the National Emphysema Treatment Trial (NETT Genetics Ancillary Study cohort. We used factor analysis to select a subset of phenotypic variables, and then used cluster analysis to identify subtypes of severe emphysema. We examined the phenotypic and genotypic characteristics of each cluster. Results We identified six factors accounting for 75% of the shared variability among our initial phenotypic variables. We selected four phenotypic variables from these factors for cluster analysis: 1 post-bronchodilator FEV1 percent predicted, 2 percent bronchodilator responsiveness, and quantitative CT measurements of 3 apical emphysema and 4 airway wall thickness. K-means cluster analysis revealed four clusters, though separation between clusters was modest: 1 emphysema predominant, 2 bronchodilator responsive, with higher FEV1; 3 discordant, with a lower FEV1 despite less severe emphysema and lower airway wall thickness, and 4 airway predominant. Of the genotypes examined, membership in cluster 1 (emphysema-predominant was associated with TGFB1 SNP rs1800470. Conclusions Cluster analysis may identify meaningful disease subtypes and/or groups of related phenotypic variables even in a highly selected group of severe emphysema subjects, and may be useful for genetic association studies.

  4. [Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema].

    Science.gov (United States)

    Bocquillon, V; Briault, A; Reymond, E; Arbib, F; Jankowski, A; Ferretti, G; Pison, C

    2016-11-01

    In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  5. A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

    Directory of Open Access Journals (Sweden)

    Nicola Scichilone

    2009-01-01

    Full Text Available We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

  6. Association between markers of emphysema and more severe chronic obstructive pulmonary disease

    Science.gov (United States)

    Boschetto, P; Quintavalle, S; Zeni, E; Leprotti, S; Potena, A; Ballerin, L; Papi, A; Palladini, G; Luisetti, M; Annovazzi, L; Iadarola, P; De Rosa, E; Fabbri, L M; Mapp, C E

    2006-01-01

    Background The predominant emphysema phenotype is associated with more severe airflow limitation in patients with chronic obstructive pulmonary disease (COPD). A study was undertaken to investigate whether COPD patients, with or without emphysema quantitatively confirmed by high resolution computed tomography (HRCT), have different COPD severity as assessed by the BODE index (body mass index, airflow obstruction, dyspnoea, exercise performance) and inspiratory capacity to total lung capacity ratio (IC/TLC), and by different biological markers of lung parenchymal destruction. Methods Twenty six outpatients with COPD and eight healthy non‐smokers were examined. Each subject underwent HRCT scanning, pulmonary function tests, cell counts, and measurements of neutrophil elastase, matrix metalloproteinase (MMP)‐9 and tissue inhibitor of metalloproteinase (TIMP)‐1 in induced sputum, as well as measurement of desmosine, a marker of elastin degradation in urine, plasma and sputum. Results Patients with HRCT confirmed emphysema had a higher BODE index and lower IC/TLC ratio than subjects without HRCT confirmed emphysema and controls. Forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity ratio, and carbon monoxide transfer coefficient were lower, whereas the number of eosinophils, MMP‐9, and the MMP‐9/TIMP‐1 ratio in sputum were higher in patients with emphysema. In COPD patients the number of sputum eosinophils was the biological variable that correlated positively with the HRCT score of emphysema (p = 0.04). Conclusions These results suggest that COPD associated with HRCT confirmed emphysema is characterised by more severe lung function impairment, more intense airway inflammation and, possibly, more serious systemic dysfunction than COPD not associated with HRCT confirmed emphysema. PMID:16769715

  7. Incidental lung volume reduction following fulminant pulmonary hemorrhage in a patient with severe emphysema.

    Science.gov (United States)

    Hetzel, Juergen; Spengler, Werner; Horger, Marius; Boeckeler, Michael

    2015-06-01

    Endoscopic lung volume reduction is an emerging technique meant to improve lung function parameters, quality of life, and exercise tolerance in patients with severe lung emphysema. This is the first report of lung volume reduction by autologous blood in a patient with non-bullous lung emphysema. A 74-year-old woman with heterogeneous lung emphysema developed accidentally diffuse lobar bleeding immediately after valve placement. Due to persistent hemorrhage, the valves had to be removed shortly thereafter. Despite extraction of the valves, respiratory function of the patient improved rapidly indicated also by a drop in the COPD assessment test questionnaire, 3 months later. This was consistent with both improvement of lung function tests and six-minute walking test.

  8. Serum Proteins Associated with Emphysema Progression in Severe Alpha-1 Antitrypsin Deficiency.

    Science.gov (United States)

    Beiko, Tatsiana; Janech, Michael G; Alekseyenko, Alexander V; Atkinson, Carl; Coxson, Harvey O; Barth, Jeremy L; Stephenson, Sarah E; Wilson, Carole L; Schnapp, Lynn M; Barker, Alan; Brantly, Mark; Sandhaus, Robert A; Silverman, Edwin K; Stoller, James K; Trapnell, Bruce; Charlie, Strange

    2017-07-15

    Computed tomography (CT) lung density is an accepted biomarker for emphysema in alpha-1 antitrypsin deficiency (AATD), although concerns for radiation exposure limit its longitudinal use. Serum proteins associated with emphysema, particularly in early disease, may provide additional pathogenic insights. We investigated whether distinct proteomic signatures characterize the presence and progression of emphysema in individuals with severe AATD and normal forced expiratory volume in 1 second (FEV 1 ). QUANT itative lung CT U n M asking emphysema progression in AATD (QUANTUM-1) is a multicenter, prospective 3-year study of 49 adults with severe AATD and FEV 1 post-bronchodilator values (Post-BD) ≥ 80% predicted. All participants received chest CT, serial spirometry, and contributed to the serum biobank. Volumetric imaging display and analysis (VIDA) software defined the baseline 15 th percentile density (PD15) which was indexed to CT-derived total lung capacity (TLC). We measured 317 proteins using a multiplexed immunoassay (Myriad Discovery MAP ® panel) in 31 individuals with a complete dataset. We analyzed associations between initial PD15/TLC, PD15/TLC annual decline, body mass index (BMI), and protein levels using Pearson's product moment correlation. C-reactive protein (CRP), adipocyte fatty acid-binding protein (AFBP), leptin, and tissue plasminogen activator (tPA) were found to be associated with baseline emphysema and all but leptin were associated with emphysema progression after adjustments were made for age and sex. All 4 proteins were associated with BMI after further adjustment for multiple comparisons was made. The relationship between these proteins and BMI, and further validation of these findings in replicative cohorts require additional studies.

  9. The minimal important difference for residual volume in patients with severe emphysema

    NARCIS (Netherlands)

    Hartman, Jorine E.; ten Hacken, Nick H. T.; Klooster, Karin; Boezen, H. Marike; de Greef, Mathieu H. G.; Slebos, Dirk-Jan

    2012-01-01

    Residual volume (RV) measured by body plethysmography is a routine measurement in clinical pulmonary practice and is often an important outcome variable in clinical trials. However, it is not known what size of improvement can be regarded as being important in severe emphysema patients. Therefore,

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

    NARCIS (Netherlands)

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

    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

  11. 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

  12. Effect of Emphysema Severity on the Apnea–Hypopnea Index in Smokers with Obstructive Sleep Apnea

    Science.gov (United States)

    Tiwari, Rachna; Vega, Maria Elena; Yu, Daohai; Soler, Xavier; Jaffe, Fredric; Kim, Victor; Swift, Irene; D’Alonzo, Gilbert E.; Criner, Gerard J.

    2016-01-01

    Rationale: The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated. Objectives: To evaluate the importance of lung inflation on OSA severity (apnea–hypopnea index [AHI]) in smokers with suspected OSA. Methods: Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m2) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping. Measurements and Main Results: For the group overall, there was evidence of obstructive airway disease by spirometry (FEV1, 1.4 ± 0.5 L, 58 ± 14% predicted) and emphysema by quantitative CT (CT-derived percent emphysema, 11 ± 13%; CT-derived percent gas trapping, 31.6 ± 24.1%). Twenty-nine (57%) of the patients had OSA (AHI, 18 ± 12 events/h). Patients with OSA had a higher BMI but were younger than those without OSA (BMI, 35 ± 9 kg/m2 vs. 29 ± 7 kg/m2, respectively [P = 0.007]; age, 56 ± 8 yr vs. 62 ± 9 yr, respectively [P = 0.01]). There was an inverse correlation between the AHI and the CT-derived percent emphysema and CT-derived percent gas trapping, both for the entire group (r = −0.41 [P smokers with OSA, increased gas trapping and emphysema as assessed by CT are associated with a decreased AHI. Along with sex and BMI, these measurements may be important in determining the severity of OSA in patients with COPD and may offer a protective mechanism in patients with more

  13. Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea.

    Science.gov (United States)

    Krachman, Samuel L; Tiwari, Rachna; Vega, Maria Elena; Yu, Daohai; Soler, Xavier; Jaffe, Fredric; Kim, Victor; Swift, Irene; D'Alonzo, Gilbert E; Criner, Gerard J

    2016-07-01

    The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated. To evaluate the importance of lung inflation on OSA severity (apnea-hypopnea index [AHI]) in smokers with suspected OSA. Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m(2)) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping. For the group overall, there was evidence of obstructive airway disease by spirometry (FEV1, 1.4 ± 0.5 L, 58 ± 14% predicted) and emphysema by quantitative CT (CT-derived percent emphysema, 11 ± 13%; CT-derived percent gas trapping, 31.6 ± 24.1%). Twenty-nine (57%) of the patients had OSA (AHI, 18 ± 12 events/h). Patients with OSA had a higher BMI but were younger than those without OSA (BMI, 35 ± 9 kg/m(2) vs. 29 ± 7 kg/m(2), respectively [P = 0.007]; age, 56 ± 8 yr vs. 62 ± 9 yr, respectively [P = 0.01]). There was an inverse correlation between the AHI and the CT-derived percent emphysema and CT-derived percent gas trapping, both for the entire group (r = -0.41 [P smokers with OSA, increased gas trapping and emphysema as assessed by CT are associated with a decreased AHI. Along with sex and BMI, these measurements may be important in determining the severity of OSA in patients with COPD and may offer a protective mechanism in patients with more advanced disease.

  14. 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.

  15. Thyroid Emphysema Following Penetrating Neck Trauma

    OpenAIRE

    Demet Karadağ; Egemen Doner; Baki Adapınar

    2011-01-01

    Although traumatic thyroid gland rupture or hemorrhage is usually seen in goitrous glands, injuries of the normal thyroid gland after neck trauma have rarely been described in the literature. We describe a 44-year-old man who presented with thyroid emphysema and subcutaneous emphysema (SCE) that occurred after penetrating neck trauma. CT images showed complete resolution of thyroid emphysema and subcutaneous emphysema at follow-up examination. Neck injuries can be life threatening. After pene...

  16. Traumatic transconjunctival orbital emphysema.

    OpenAIRE

    Stroh, E M; Finger, P T

    1990-01-01

    Orbital emphysema can be produced by trans-conjunctival migration of air from a high pressure airgun. In an industrial accident an 8 mm conjunctival laceration was produced in the superior fornix which acted as a portal of entry for air into the subconjunctival, subcutaneous, and retrobulbar spaces. Computed tomography revealed no evidence of orbital fracture and showed that traumatic orbital emphysema occurred without a broken orbital bone.

  17. Microbiological airway colonization in COPD patients with severe emphysema undergoing endoscopic lung volume reduction

    Directory of Open Access Journals (Sweden)

    Trudzinski FC

    2017-12-01

    Full Text Available Franziska C Trudzinski,1 Frederik Seiler,1 Heinrike Wilkens,1 Carlos Metz,1 Annegret Kamp,1 Robert Bals,1 Barbara Gärtner,2 Philipp M Lepper,1 Sören L Becker2–4 1Department of Internal Medicine V – Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, University Medical Center Saarland and Saarland University, 2Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany; 3Swiss Tropical and Public Health Institute, 4University of Basel, Basel, Switzerland Background: Endoscopic lung volume reduction (eLVR is a therapeutic option for selected patients with COPD and severe emphysema. Infectious exacerbations are serious events in these vulnerable patients; hence, prophylactic antibiotics are often prescribed postinterventionally. However, data on the microbiological airway colonization at the time of eLVR are scarce, and there are no evidence-based recommendations regarding a rational antibiotic regimen.Objective: The aim of this study was to perform a clinical and microbiological analysis of COPD patients with advanced emphysema undergoing eLVR with endobronchial valves at a single German University hospital, 2012–2017.Patients and methods: Bronchial aspirates were obtained prior to eLVR and sent for microbiological analysis. Antimicrobial susceptibility testing of bacterial isolates was performed, and pathogen colonization was retrospectively compared with clinical parameters.Results: At least one potential pathogen was found in 47% (30/64 of patients. Overall, Gram-negative bacteria constituted the most frequently detected pathogens. The single most prevalent species were Haemophilus influenzae (9%, Streptococcus pneumoniae (6%, and Staphylococcus aureus (6%. No multidrug resistance was observed, and Pseudomonas aeruginosa occurred in <5% of samples. Patients without microbiological airway colonization showed more severe airflow limitation, hyperinflation, and chronic hypercapnia compared

  18. CAD system for quantifying emphysema severity based on multi-class classifier using CT image and spirometry information

    International Nuclear Information System (INIS)

    Nimura, Yukitaka; Mori, Kensaku; Kitasaka, Takayuki; Honma, Hirotoshi; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi

    2010-01-01

    Many diagnosis methods based on CT image processing are proposed for quantifying emphysema. The most of these diagnosis methods extract lesions as Low-Attenuation Areas (LAA) by simple threshold processing and evaluate their severity by calculating the LAA (LAA%) in the lung. However, pulmonary emphysema is diagnosed by not only the LAA but also the changes of pulmonary blood vessel and the spirometric measurements. This paper proposes a novel computer-aided detection (CAD) system for quantifying emphysema by combining spirometric measurements and results of CT image processing. The experimental results revealed that the accuracy rate of the proposed method was 78.3%. It is 13.1% improvement compared with the method based on only the LAA%. (author)

  19. Comparing Clinical Outcomes in Upper versus Lower Lobe Endobronchial Valve Treatment in Severe Emphysema.

    Science.gov (United States)

    Eberhardt, Ralf; Herth, Felix J F; Radhakrishnan, Sri; Gompelmann, Daniela

    2015-01-01

    Lung volume reduction surgery has been recommended for patients with upper lobe predominant emphysema and was associated with less favorable outcomes in patients with non-upper lobe predominant emphysema. The value of endobronchial valve (EBV) treatment in lower lobe predominant emphysema has not been studied. To confirm the equivalence of upper and lower lobe valve treatments in patients with heterogeneous emphysema. A retrospective analysis from the Endobronchial Valve for Emphysema Palliation Trial (VENT), where patients with heterogeneous emphysema received Zephyr® EBV (Pulmonx Corp., Redwood City, Calif., USA) or medical treatment, was performed. Patients with low interlobar collateral ventilation and accurate placement of valves in the target lobes were identified. Safety and efficacy were compared between patients who underwent upper versus lower lobe treatment. Of the 331 patients, 60 had low interlobar collateral ventilation and successful lobar exclusion (45 patients with upper lobe treatment and 15 patients with lower lobe treatment). There was no difference in baseline characteristics between the groups except for a higher destruction score (70.3 vs. 60.7%; p = 0.0010) and a higher heterogeneity index (24 vs. 13%; p = 0.0005) for the upper lobe cohort. At 180 days, both groups had improved clinically. There were no significant differences in mean changes or responder rates of forced expiratory volume in 1 s (+23.8 vs. +22.9%), the St. Georges Respiratory Questionnaire (-6.50 vs. -7.53 points), the 6-min walk test (+24.1 vs. +44.0 m), target lobe volume reduction (-1,199 vs. -1,042 ml), or in the adverse event rate between both cohorts. Patients with lower and upper lobe predominant emphysema benefit equally from EBV therapy when interlobar collateral ventilation is low and lobar exclusion is achieved. Patients with lower lobe disease did not have increased adverse events compared to patients with upper lobe emphysema. © 2015 S. Karger AG, Basel.

  20. Thyroid Emphysema Following Penetrating Neck Trauma

    Directory of Open Access Journals (Sweden)

    Demet Karadağ

    2011-03-01

    Full Text Available Although traumatic thyroid gland rupture or hemorrhage is usually seen in goitrous glands, injuries of the normal thyroid gland after neck trauma have rarely been described in the literature. We describe a 44-year-old man who presented with thyroid emphysema and subcutaneous emphysema (SCE that occurred after penetrating neck trauma. CT images showed complete resolution of thyroid emphysema and subcutaneous emphysema at follow-up examination. Neck injuries can be life threatening. After penetrating neck traumas, physicians should consider subtle esophageal or tracheal laceration. Thyroid emphysema can occur as the result of penetrating neck trauma. The mechanism of emphysema of the thyroid parenchyma can be explained by the thyroid gland’s presence in a single visceral compartment that encompasses the larynx, trachea and thyroid gland. We describe an unusual case of thyroid emphysema of a normal thyroid gland following a penetrating neck injury.

  1. Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

    International Nuclear Information System (INIS)

    Park, Hyun Jeong; Hwang, Jung Hwa

    2011-01-01

    We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV 1 /FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV 1 /FVC and the dyspnea score.

  2. Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyun Jeong; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2011-09-15

    We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV{sub 1}/FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV{sub 1}/FVC and the dyspnea score.

  3. Transconjunctival orbital emphysema caused by compressed air injury: a case report.

    Science.gov (United States)

    Mathew, Sunu; Vasu, Usha; Francis, Febson; Nazareth, Colin

    2008-01-01

    Orbital emphysema following conjunctival tear in the absence of orbital wall fracture, caused by air under pressure is rare. Usually orbital emphysema is seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To the best of our knowledge, there have been only eight reports of orbital emphysema following use of compressed air during industrial work. The air under pressure is pushed through the subconjunctival space into the subcutaneous and retrobulbar spaces. We present here a rare cause of orbital emphysema in a young man working with compressed air gun. Although the emphysema was severe, there were no orbital bone fracture and the visual recovery of the patient was complete without attendant complications.

  4. Early detection of emphysema progression

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Jacobs, Sander S A M; Lo, Pechin

    2010-01-01

    Emphysema is one of the most widespread diseases in subjects with smoking history. The gold standard method for estimating the severity of emphysema is a lung function test, such as forced expiratory volume in first second (FEV1). However, several clinical studies showed that chest CT scans offer...... more sensitive estimates of emphysema progression. The standard CT densitometric score of emphysema is the relative area of voxels below a threshold (RA). The RA score is a global measurement and reflects the overall emphysema progression. In this work, we propose a framework for estimation of local...

  5. Pneumomediastinum and subcutaneous cervical emphysema ...

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2012-09-08

    Sep 8, 2012 ... features and the management options. Case Report ... Chest x-ray showed a widespread perihilar and bibasal opacities in keeping with bronchopneumonia. It also revealed streaky and bubbly lucencies in the mediastinal, supra- clavicular and chest ... facilitated by the pumping action of breathing. The air.

  6. [Role of quantitative perfusion scintigraphy evaluation in determination of the efficiency of the procedure before lung volume reduction coil treatment for severe emphysema].

    Science.gov (United States)

    Yıldız, Fidan

    2017-06-01

    Lung volume reduction coil (LVRC) is a new treatment method which exercise capacities among the patients with severe emphysema. In order to determine the emphysema distribution before LVRC treatment, we examined the contribution of combination of the high resolution computed tomography (HRCT) of the lung and the quantitative perfusion scintigraphy to the efficiency of the procedure. The study was conducted retrospectively. The densitometry analysis and scores of emphysema areas of the patients who were found suitable for LVRC treatment in HRCT were determined. Before the procedure, the quantitative lung perfusion scintigraphies were taken. Lobes which had high emphysema score and in which a decrease perfusion was observed in quantitative perfusion scintigraphy were determined as treatment areas. A total of 22 patients were treated. In HRCT it was observed that perfusion decreased in lobes in which the emphysema damage scoring was high. A significant statistical difference was found between pre-and post- procedure measurements in terms of FEV 1 , RV, and TLC (pdifference was found as 45.4 ± 23.9 m (p= 0.000). No significant difference was determined between perfusion ratios before the procedure and perfusion ratios after the procedure. The quantitative perfusion scintigraphy taken before LVRC treatment in severe emphysema patients guides to determine the target lobe for treatment and makes contribution to the efficiency of the procedure.

  7. Early detection of emphysema progression

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Jacobs, Sander S. A. M.; Lo, Pechin Chien Pau

    2010-01-01

    Emphysema is one of the most widespread diseases in subjects with smoking history. The gold standard method for estimating the severity of emphysema is a lung function test, such as forced expiratory volume in first second (FEV1). However, several clinical studies showed that chest CT scans offer...... more sensitive estimates of emphysema progression. The standard CT densitometric score of emphysema is the relative area of voxels below a threshold (RA). The RA score is a global measurement and reflects the overall emphysema progression. In this work, we propose a framework for estimation of local...... emphysema progression from longitudinal chest CT scans. First, images are registered to a common system of coordinates and then local image dissimilarities are computed in corresponding anatomical locations. Finally, the obtained dissimilarity representation is converted into a single emphysema progression...

  8. Severity of lung fibrosis affects early surgical outcomes of lung cancer among patients with combined pulmonary fibrosis and emphysema.

    Science.gov (United States)

    Mimae, Takahiro; Suzuki, Kenji; Tsuboi, Masahiro; Ikeda, Norihiko; Takamochi, Kazuya; Aokage, Keiju; Shimada, Yoshihisa; Miyata, Yoshihiro; Okada, Morihito

    2016-07-01

    Combined pulmonary fibrosis and emphysema (CPFE) is defined as upper lobe emphysema and lower lobe fibrosis, which are representative lung disorders that increase the prevalence of lung cancer. This unique disorder may affect the morbidity and mortality during the early period after surgery. The present study aimed to identify which clinicopathological features significantly affect early surgical outcomes after lung resection in nonsmall cell lung cancer (NSCLC) patients and in those with CPFE.We retrospectively assessed 2295 patients with NSCLC and found that 151 (6.6%) had CPFE. All were surgically treated between January 2008 and December 2010 at 4 institutions.The postoperative complication rates for patients with and without CPFE were 39% and 17%, respectively. The 90-day mortality rates were higher among patients with than without CPFE (7.9% vs 1%). Acute exacerbation of interstitial pneumonia was the main cause of death among 12 patients with CPFE who died within 90 days after surgery. Multivariate logistic regression analysis selected CPFE, gender, age, and clinical stage as independent predictive factors for postoperative complications, and CPFE, clinical stage, and sex for 90-day mortality. The severity of lung fibrosis on preoperative CT images was an independent predictive factor for 90-day mortality among patients with CPFE.The key predictive factor for postoperative mortality and complications of lung resection for NSCLC was CPFE. The severity of lung fibrosis was the principal predictor of early outcomes after lung surgery among patients with CPFE and NSCLC.

  9. Cervical surgical emphysema following routine tonsillectomy.

    LENUS (Irish Health Repository)

    Al Omari, B

    2011-01-01

    Complications of tonsillectomy have been well documented. However spontaneous subcutaneous emphysema of the neck following tonsillectomy has rarely been described. We report a case of this complication in a young female patient.

  10. Contribution of pulmonary emphysema to functional impairment in patients with severe chronic obstructive pulmonary disease. A high-resolution CT study

    International Nuclear Information System (INIS)

    Zompatori, M.; Fasano, L.; Battista, G.

    1999-01-01

    The purpose of the paper is to investigate whether high-resolution CT (HRCT) can detect the subjects with massive emphysematous destruction in a group of patients with severe chronic obstructive pulmonary disease (COPD) and therefor be of help in selecting the candidates to surgical lung volume reduction. Have been examined 40 former smokers with severe COPD (FEV 1 ≤40% of the predicted value, with no major improvement after inhalation of bronchodilators). The emphysema extent score was significantly correlated with the hematocrit value and Tiffeneau index (p 1 was significantly correlated with emphysema extent (p [it

  11. Subcutaneous methotrexate for symptomatic control of severe recalcitrant psoriasis: safety, efficacy, and patient acceptability

    Directory of Open Access Journals (Sweden)

    Manalo IF

    2015-05-01

    Full Text Available Iviensan F Manalo,1 Kathleen E Gilbert,2 Jashin J Wu3 1Medical College of Georgia, Georgia Regents University, Augusta, GA, 2Indiana University School of Medicine, Indianapolis, IN, 3Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA Background: Although oral methotrexate is an effective first-line traditional systemic therapy for psoriasis, the use of the subcutaneous form of methotrexate for the treatment of psoriasis has not been fully established. Objective: This study is a literature review of the research related to the safety, efficacy, and patient acceptability of subcutaneous methotrexate for its application in the treatment of severe recalcitrant psoriasis. Methods: Systematic literature searches were conducted of the PubMed, Ovid, and ClinicalTrials.gov databases. Results: Only three relevant sources of literature were found studying subcutaneous methotrexate specifically in the context of psoriasis. Of these, only one clinical trial was found to directly study the use of subcutaneous methotrexate in psoriasis patients; however, results of this study have not been published. The other two literature sources involved a cost-effectiveness analysis and a literature review for subcutaneous methotrexate. Otrexup™ and Rasuvo™ are two particular single-use auto-injector modalities of subcutaneous methotrexate that are approved by the US Food and Drug Administration. The equivalents of Rasuvo available in countries outside of the USA are advertised as Metoject® or Metex®. Much more research has been conducted on the use of subcutaneous methotrexate in rheumatoid arthritis patients. Conclusion: There is a lack of original evidence-based studies evaluating the use of subcutaneous methotrexate specifically for the treatment of psoriasis. Based on the more extensively researched data on the safety, efficacy, and patient acceptability of subcutaneous methotrexate in rheumatoid arthritis patients

  12. Endobronchial valves in severe emphysematous patients: CT evaluation of lung fissures completeness, treatment radiological response and quantitative emphysema analysis

    Energy Technology Data Exchange (ETDEWEB)

    Koenigkam-Santos, Marcel, E-mail: marcelk46@yahoo.com.br, E-mail: marcelk46@usp.b [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Hospital das Clinicas da Faculdade de Medicina; Paula, Wagner Diniz de [University of Brasilia (UnB), DF (Brazil). Brasilia University Hospital; Gompelmann, Daniela [University of Heidelberg (Germany). Department of Pneumology and Respiratory Medicine of the Chest Clinic (Thoraxklinik); Kauczor, Hans-Ulrich [University of Heidelberg (Germany). Department of Diagnostic and Interventional Radiology; Heussel, Claus Peter; Puderbach, Michael [University of Heidelberg (Germany). Department of Diagnostic and Interventional Radiology with Nuclear Medicine of the Chest Clinic (Thoraxklinik)

    2013-01-15

    Objective: To evaluate lung fissures completeness, post-treatment radiological response and quantitative CT analysis (QCTA) in a population of severe emphysematous patients submitted to endobronchial valves (EBV) implantation. Materials and Methods: Multi-detectors CT exams of 29 patients were studied, using thin-section low dose protocol without contrast. Two radiologists retrospectively reviewed all images in consensus; fissures completeness was estimated in 5% increments and post-EBV radiological response (target lobe atelectasis/volume loss) was evaluated. QCTA was performed in pre and post-treatment scans using a fully automated software. Results: CT response was present in 16/29 patients. In the negative CT response group, all 13 patients presented incomplete fissures, and mean oblique fissures completeness was 72.8%, against 88.3% in the other group. QCTA most significant results showed a reduced post-treatment total lung volume (LV) (mean 542 ml), reduced EBV-submitted LV (700 ml) and reduced emphysema volume (331.4 ml) in the positive response group, which also showed improved functional tests. Conclusion: EBV benefit is most likely in patients who have complete interlobar fissures and develop lobar atelectasis. In patients with no radiological response we observed a higher prevalence of incomplete fissures and a greater degree of incompleteness. The fully automated QCTA detected the post-treatment alterations, especially in the treated lung analysis. (author)

  13. An preliminary clinical study of transbronchoscopic interventional treatment for severe emphysema with local made one-way valvular stents

    International Nuclear Information System (INIS)

    Fan Yong; Wu Qi; Liang Chunbao; Wu Xianjie; Tian Jing; Du Zhongzhen; Li Ping; Wu Junping; Shi Lixia; Zhao Chongfa; Li Yuping; Yu Lei; He Nengshu

    2008-01-01

    Objective: To evaluate the safety and efficiency of bronchoscopic interventional lung volume reduction with domestic-made stents. Methods: The target areas of 7 patients with severe emphysema for valvular stenting form May 2006 to Aug. 2007 were prospectively selected on the basis of CT scan. Under general anesthesia, one-way valvular stenting were carried out over a guidewire under flexible bronchoscopy and fluoroscopic control. The symptom, pulmonary function, blood gas analysis, B-ultrasonic wave, 6 minute walk distance and thoracic CT were undertaken. Results: 4-6 stents per patient took place in 136 ± 72.3 min to obstruct the upper-lobe segments unilaterally but without obvious atelectasis under imaging. The patients could walk 2 hours after the operation with relief of dyspnea. No major change in radiologic findings and lung function occurred in 2 weeks, only bronchi distal to the stents gathered together. 6-min walk distance, Borg dyspnea scale fell and the pulmonary arterial pressure showed significant (P<0.05)statistical discrepancy. No major life-threatening complications were noted in the 15-day study period and no conspicuous change in lung function, blood gas analysis and lung volume. Lower-lobe pneumonia of nontarget area developed in 1 patient and acute episode of COPD occurred in another. Conclusions: Bronchoscopic interventional lung volume reduction may improve dyspnea and quality of life, as a rather safety therapeutic measure. (authors)

  14. A method for the automatic quantification of the completeness of pulmonary fissures: evaluation in a database of subjects with severe emphysema

    International Nuclear Information System (INIS)

    Rikxoort, Eva M. van; Goldin, Jonathan G.; Galperin-Aizenberg, Maya; Abtin, Fereidoun; Kim, Hyun J.; Lu, Peiyun; Shaw, Greg; Brown, Matthew S.; Ginneken, Bram van

    2012-01-01

    To propose and evaluate a technique for automatic quantification of fissural completeness from chest computed tomography (CT) in a database of subjects with severe emphysema. Ninety-six CT studies of patients with severe emphysema were included. The lungs, fissures and lobes were automatically segmented. The completeness of the fissures was calculated as the percentage of the lobar border defined by a fissure. The completeness score of the automatic method was compared with a visual consensus read by three radiologists using boxplots, rank sum tests and ROC analysis. The consensus read found 49% (47/96), 15% (14/96) and 67% (64/96) of the right major, right minor and left major fissures to be complete. For all fissures visually assessed as being complete the automatic method resulted in significantly higher completeness scores (mean 92.78%) than for those assessed as being partial or absent (mean 77.16%; all p values <0.001). The areas under the curves for the automatic fissural completeness were 0.88, 0.91 and 0.83 for the right major, right minor and left major fissures respectively. An automatic method is able to quantify fissural completeness in a cohort of subjects with severe emphysema consistent with a visual consensus read of three radiologists. (orig.)

  15. The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity.

    LENUS (Irish Health Repository)

    O'Connell, Jean

    2012-02-01

    OBJECTIVE: Several studies have reported the existence of a subgroup of obese individuals with normal metabolic profiles. It remains unclear what factors are responsible for this phenomenon. We proposed that adipocyte size might be a key factor in the protection of metabolically healthy obese (MHO) individuals from the adverse effects of obesity. SUBJECTS: Thirty-five patients undergoing bariatric surgery were classified as MHO (n = 15) or metabolically unhealthy obese (MUO, n = 20) according to cut-off points adapted from the International Diabetes Federation definition of the metabolic syndrome. Median body mass index (BMI) was 48 (range 40-71). RESULTS: There was a moderate correlation between omental adipocyte size and subcutaneous adipocyte size (r = 0.59, p<0.05). The MHO group had significantly lower mean omental adipocyte size (80.9+\\/-10.9 microm) when compared with metabolically unhealthy patients (100.0+\\/-7.6 microm, p<0.0001). Mean subcutaneous adipocyte size was similar between the two groups (104.1+\\/-8.5 microm versus 107.9+\\/-7.1 microm). Omental, but not subcutaneous adipocyte size, correlated with the degree of insulin resistance as measured by HOMA-IR (r = 0.73, p<0.0005), as well as other metabolic parameters including triglyceride\\/HDL-cholesterol ratio and HbA1c. Twenty-eight patients consented to liver biopsy. Of these, 46% had steatohepatitis and fibrosis. Fifty percent (including all the MHO patients) had steatosis only. Both omental and subcutaneous adipocyte size were significantly associated with the degree of steatosis (r = 0.66, p<0.0001 and r = 0.63, p<0.005 respectively). However, only omental adipocyte size was an independent predictor of the presence or absence of fibrosis. CONCLUSION: Metabolically healthy individuals are a distinct subgroup of the severely obese. Both subcutaneous and omental adipocyte size correlated positively with the degree of fatty liver, but only omental adipocyte size was related to metabolic health

  16. Traumatic retropharyngeal emphysema as a cause for severe respiratory distress in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Barlev, Dan M. [Division of Pediatric Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Division of Pediatric Radiology, Schneider Children' s Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040 (United States); Nagourney, Beth A.; Saintonge, Ronald [Division of Neonatology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States)

    2003-06-01

    Traumatic injury to the pharynx or esophagus in a newborn from intubation or tube suctioning may have various presentations. Difficulty passing a gastric tube or feeding problems may erroneously suggest the diagnosis of esophageal atresia. Associated respiratory distress may be caused by pneumothorax or pleural effusion if the pleural space is entered. We report the case of a full-term newborn presenting with severe respiratory distress caused by a large retropharyngeal air collection resulting from hypopharyngeal perforation from prior intubation and suctioning. Chest abnormality, sufficient to account for the degree of respiratory distress, was not demonstrated. (orig.)

  17. Enfisema subcutâneo pós-amigdalectomia: relato de caso Enfisema subcutáneo después de amigdalectomia: relato del caso Subcutaneous emphysema after tonsillectomy: case report

    Directory of Open Access Journals (Sweden)

    Walter Luiz Ferreira Lima

    2005-08-01

    cirugía, se notó un edema crepitante y depresible en el cuello y en la región parotídea izquierda, característico de enfisema subcutáneo. La tomografía computadorizada mostró la existencia de aire en las regiones malar y cervical (principalmente a la izquierda, alcanzando hasta el mediastino superior. No hubo obstrucción de las vías aéreas y el estado general del paciente permaneció estable. Tuvo alta hospitalario en el día siguiente y fue acompañado en el ambulatorio. El enfisema retrocedió totalmente después de 10 días. CONCLUSIONES: El enfisema subcutáneo es una complicación rara de la amigdalectomia, ocurriendo casi siempre después de disecciones profundas de la mucosa faríngea, cuando se crea interface porosa que proporciona la entrada del aire. El aumento de la presión en las vías aéreas superiores puede contribuir para el problema.BACKGROUND AND OBJECTIVES: Tonsillectomy is considered a relatively safe procedure. This report aimed at describing an uncommon complication of this surgical procedure: subcutaneous emphysema. CASE REPORT: Male patient, 25 years old, admitted for recurrent tonsillitis and hypertrophic nasal turbinates. Tonsillectomy and nasal cauterization were performed under general anesthesia with tracheal intubation. Surgery was uneventful. At post-anesthetic recovery unit (PACU, patient was agitated and performing major physical effort. Four hours after surgery, gross and crepitus swelling of neck and left parotid region, typical of subcutaneous emphysema, was noted. CT scan has revealed free air in the malar and cervical regions (especially to the left, reaching upper mediastinum. There was no airway obstruction and his general condition was stable. Patient was discharged one day after and was followed on ambulatory basis. Emphysema was no longer clinically evident 10 days after. CONCLUSIONS: Subcutaneous emphysema is an uncommon complication of tonsillectomy, appearing almost ever after deeper dissections of the pharyngeal

  18. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    International Nuclear Information System (INIS)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C.; Pifferi, M.; Baldini, G.

    1997-01-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.)

  19. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    Energy Technology Data Exchange (ETDEWEB)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C. [Department of Radiology, University of Pisa, Via Roma 67, I-56 100 Pisa (Italy); Pifferi, M.; Baldini, G. [Department of Pediatrics, University of Pisa, Pisa (Italy)

    1997-12-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.) With 2 figs., 9 refs.

  20. Pulmonary emphysema in a neonate with Marfan syndrome

    International Nuclear Information System (INIS)

    Day, D.L.; Burke, B.A.

    1986-01-01

    A premature infant with arachnodactyly and congential cyanotic heart disease had severe pulmonary emphysema, a little-known manifestation of Marfan syndrome. The possible etiologies of emphysema in this syndrome are discussed. (orig.)

  1. Pulmonary emphysema in a neonate with Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Day, D.L.; Burke, B.A.

    1986-09-01

    A premature infant with arachnodactyly and congential cyanotic heart disease had severe pulmonary emphysema, a little-known manifestation of Marfan syndrome. The possible etiologies of emphysema in this syndrome are discussed.

  2. Browning of Subcutaneous White Adipose Tissue in Humans after Severe Adrenergic Stress.

    Science.gov (United States)

    Sidossis, Labros S; Porter, Craig; Saraf, Manish K; Børsheim, Elisabet; Radhakrishnan, Ravi S; Chao, Tony; Ali, Arham; Chondronikola, Maria; Mlcak, Ronald; Finnerty, Celeste C; Hawkins, Hal K; Toliver-Kinsky, Tracy; Herndon, David N

    2015-08-04

    Since the presence of brown adipose tissue (BAT) was confirmed in adult humans, BAT has become a therapeutic target for obesity and insulin resistance. We examined whether human subcutaneous white adipose tissue (sWAT) can adopt a BAT-like phenotype using a clinical model of prolonged and severe adrenergic stress. sWAT samples were collected from severely burned and healthy individuals. A subset of burn victims were prospectively followed during their acute hospitalization. Browning of sWAT was determined by the presence of multilocular adipocytes, uncoupling protein 1 (UCP1), and increased mitochondrial density and respiratory capacity. Multilocular UCP1-positive adipocytes were found in sWAT samples from burn patients. UCP1 mRNA, mitochondrial density, and leak respiratory capacity in sWAT increased after burn trauma. Our data demonstrate that human sWAT can transform from an energy-storing to an energy-dissipating tissue, which opens new research avenues in our quest to prevent and treat obesity and its metabolic complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy.

    Science.gov (United States)

    Nandate, Koichiro; Voelzke, Bryan B

    2016-01-01

    Indigo carmine (also known as 5,5'-indigodisulfonic acid sodium salt or indigotine) is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation) was 75% on 40% inspired oxygen concentration), poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg), hydrocortisone (100 mg), diphenhydramine (50 mg), albuterol nebulizer (0.083%), and continuous infusion of epinephrine (0.15 μg/kg/min), the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function.

  4. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy

    Directory of Open Access Journals (Sweden)

    Koichiro Nandate

    2016-01-01

    Full Text Available Indigo carmine (also known as 5,5′-indigodisulfonic acid sodium salt or indigotine is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation was 75% on 40% inspired oxygen concentration, poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg, hydrocortisone (100 mg, diphenhydramine (50 mg, albuterol nebulizer (0.083%, and continuous infusion of epinephrine (0.15 μg/kg/min, the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function.

  5. Massive subcutaneous emphysema after traumatic pneumothorax ...

    African Journals Online (AJOL)

    A 52-year-old man was admitted to our hospital emergency room for dyspnea and extensive chest swelling. He had a right chest trauma after falling over the bathtub. He was hemodynamically stable and on physical examination he had right chest hypoventilation with hypoxemia. The swelling quickly progressed to the ...

  6. [Lung volume reduction surgery for emphysema and bullous pulmonary emphysema].

    Science.gov (United States)

    Le Pimpec-Barthes, F; Das Neves-Pereira, J-C; Cazes, A; Arame, A; Grima, R; Hubsch, J-P; Zukerman, C; Hernigou, A; Badia, A; Bagan, P; Delclaux, C; Dusser, D; Riquet, M

    2012-04-01

    The improvement of respiratory symptoms for emphysematous patients by surgery is a concept that has evolved over time. Initially used for giant bullae, this surgery was then applied to patients with diffuse microbullous emphysema. The physiological and pathological concepts underlying these surgical procedures are the same in both cases: improve respiratory performance by reducing the high intrapleural pressure. The functional benefit of lung volume reduction surgery (LVRS) in the severe diffuse emphysema has been validated by the National Emphysema Treatment Trial (NETT) and the later studies which allowed to identify prognostic factors. The quality of the clinical, morphological and functional data made it possible to develop recommendations now widely used in current practice. Surgery for giant bullae occurring on little or moderately emphysematous lung is often a simpler approach but also requires specialised support to optimize its results. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  7. Subcutaneous blood flow over 24-hour periods in patients with severe leg ischaemia

    DEFF Research Database (Denmark)

    Bjerre-Jepsen, K; Faris, I; Henriksen, O

    1982-01-01

    This paper describes a method for studying the clearance of 133Xenon from the subcutaneous tissue of the calf and foot over 24-h periods. The average blood flow over this period can be estimated from the clearance constant obtained. Two series of measurement of the radioactivity are made, the fir...

  8. Severe dermatomyositis with pronounced generalized subcutaneous edema and dysphagia: A rare manifestation of a highly active disease

    Directory of Open Access Journals (Sweden)

    Amy Chia-Ying Peng

    2014-06-01

    Full Text Available Severe subcutaneous edema is rare in dermatomyositis (DM. Such patients usually have a highly active disease, which requires aggressive treatment. To date, there are 14 reported cases of generalized edema secondary to adult DM. We described a severe case of DM manifesting generalized edema, oropharyngeal dysphagia, and dysarthria. A 44-year-old female presented with a typical rash of DM, proximal muscle weakness, and marked swelling of the limbs and face. The findings in the skin biopsy, muscle enzymes, and electromyography were consistent with DM. No internal malignancy was detected. After a brief initial response to oral dexamethasone, the patient experienced a sudden worsening of muscle weakness with dysarthria and an inability to swallow even saliva. A magnetic resonance imaging study revealed edema of the subcutaneous tissue and muscles. The symptoms improved gradually in 2 months after intravenous pulse corticosteroid therapy. Generalized subcutaneous edema is a very rare manifestation of DM that can occur as a presenting symptom. It appears to be a hallmark of a severe DM that requires prompt and aggressive treatment. Additional cases are needed to establish guidelines for treatment of this rare variant.

  9. Volume of emphysema.

    OpenAIRE

    Turner, P; Whimster, W F

    1981-01-01

    A method of determining the volume of emphysema in excised lungs is presented, with its validation. This method is based on macroscopic point counting using a perforated grid but only the holes (points) overlying emphysema need be counted to produce results within a percentage standard error of 5%. Application of the method shows that an adequate assessment of emphysema cannot be made from one lung slice alone, and that the amount of emphysema found in one lung cannot be used to predict the a...

  10. Elastase-induced emphysema in guinea pigs

    International Nuclear Information System (INIS)

    Loscutoff, S.M.

    1979-01-01

    Pulmonary function changes measured in guinea pigs 4 to 5 wk following intratracheal instillation of crystalline porcine pancreatic elastase resembled comparable changes in humans with moderately severe pulmonary emphysema. Compared with saline-treated controls, elastase-treated animals had increased values for all divisions of lung volume, increased static compliance and prolonged time constants. Since humans with emphysema are especially sensitive to air pollutants, elastase-treated animals may be useful as sensitive animal models in inhalatio toxicology

  11. Crowdsourced emphysema assessment

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Petersen, Jens; Thomsen, Laura H.

    2017-01-01

    Classification of emphysema patterns is believed to be useful for improved diagnosis and prognosis of chronic obstructive pulmonary disease. Emphysema patterns can be assessed visually on lung CT scans. Visual assessment is a complex and time-consuming task performed by experts, making it unsuita...

  12. Postthrombotic or non-postthrombotic severe venous insufficiency: impact of removal of superficial venous reflux with or without subcutaneous fasciotomy.

    Science.gov (United States)

    Christenson, Jan T

    2007-08-01

    Severe chronic venous insufficiency is often associated with therapy-resistant or recurrent venous leg ulcers, either as a result of deep vein thrombosis (DVT)- (postthrombotic syndrome [PTS]) or superficial venous insufficiency (SVI). Frequently present dermatoliposclerosis affects the skin as well as the subcutaneous and subfascial structures, which may impact tissue pressures and compromise skin perfusion. This study was undertaken to measure tissue pressures in PTS and SVI limbs and to evaluate the impact of removal of superficial venous reflux with or without concomitant subcutaneous fasciotomy. In eight patients with recurrent, therapy-resistant venous leg ulcers, due to PTS (11 limbs, 12 ulcers) and 14 patients with severe SVI (14 limbs, 14 ulcers), subcutaneous fasciotomy was performed in addition to removal of superficial reflux. They were compared with eight patients with PTS (11 limbs, 11 ulcers) and 10 patients with SVI (13 limbs, 13 ulcers) who did not have fasciotomy in addition to removal of their superficial venous reflux. Intramuscular (i.m.) and subcutaneous (s.c.) tissue pressures and transcutaneous oxygen tension (TcPO(2)) were measured prior to, immediately after, and 3 months following the surgical intervention. Healing of ulcer (spontaneous or by skin grafting) at 3 months was also observed. There were no statistical differences between the groups regarding gender and age distribution or ulcer age at the time of surgery. All patients had in addition to surgery compression stockings class II (30 mm Hg). The i.m. tissue pressure was higher in patients with PTS compared with SVI patients, while s.c. tissue pressure and TcPO(2) did not differ between the groups. When fasciotomy was performed, i.m. and s.c. tissue pressures decreased and TcPO(2) increased significantly. Without fasciotomy, only s.c. tissue pressure decreased first at 3 months postoperatively. In the SVI-group, i.m tissue pressure was significantly decreased at 3 months in the

  13. Crowdsourced emphysema assessment

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Cheplygina, Veronika; Petersen, Jens

    2017-01-01

    Classification of emphysema patterns is believed to be useful for improved diagnosis and prognosis of chronic obstructive pulmonary disease. Emphysema patterns can be assessed visually on lung CT scans. Visual assessment is a complex and time-consuming task performed by experts, making it unsuita......Classification of emphysema patterns is believed to be useful for improved diagnosis and prognosis of chronic obstructive pulmonary disease. Emphysema patterns can be assessed visually on lung CT scans. Visual assessment is a complex and time-consuming task performed by experts, making...... it unsuitable for obtaining large amounts of labeled data. We investigate if visual assessment of emphysema can be framed as an image similarity task that does not require expert. Substituting untrained annotators for experts makes it possible to label data sets much faster and at a lower cost. We use crowd...

  14. In-effort perfusion pulmonary tomo-scintigraphies for pre-surgery evaluation of severe emphysema; Tomoscintigraphies pulmonaires de perfusion a l`effort pour l`evaluation preoperatoire des emphysemateux severes

    Energy Technology Data Exchange (ETDEWEB)

    Poiseau, E. [Service de Medecine Nucleaire, Hopital Beaujon, Clichy (France); Roue, C. [Service de Pneumologie, Hopital Beaujon, Clichy (France); Bonnin, F.; Stievenart, J.L. [Service de Medecine Nucleaire, Hopital Beaujon, Clichy (France); Fournier, M. [Service de Pneumologie, Hopital Beaujon, Clichy (France); Bok, B. [Service de Medecine Nucleaire, Hopital Beaujon, Clichy (France)

    1997-12-31

    The pulmonary reduction surgery improves the in-effort tolerance of certain severe emphysema, possibly by the compression of zones of adjacent healthy pulmonary parenchyma. Six patients afflicted with severe emphysema (5 M and 1 F, 20 to 63 years old) benefited at each 3 days by an at-rest and in-effort perfusion pulmonary tomo-scintigraphy (PPTS), after a trial interval of 6 minutes. After injection IV of 6 mCi of MAA-{sup 99m}Tc, in sitting position, 120 projection images were acquired with a single-head camera on a 128 x 128 matrix, with a high resolution collimator. After reconstruction with a Metz filter, without corrections of attenuations, the coronal and cross sections were recorded on films in a standard procedure. These were visually interpreted by two independent senior physicians. The procedure has been tolerated by all the patients. Differences of pulmonary perfusion occurred at rest in comparison with the in-effort condition in 4 patients. In all the cases concerned were the zones of pulmonary parenchyma appearing as strongly injured in tomodensitometry. The in-effort pulmonary perfusion improves in 3 patients and impairs in one patient. The role of bubble and implied pulmonary diseases in the deterioration of pulmonary function, respectively, is difficult to estimate. The improvement of in-effort pulmonary perfusion could suggest the persistence of functional pulmonary tissue. On the other side, its deterioration could express the compressive character of bubbles and thus could be an indicator of severity. The observation during this pilot study of the differences between at-rest and in-effort pulmonary perfusion urges utilisation of a tool of analysis of image superposition (PPTS and scans) to study in a group of patients the correlations between the perfusion variations and the post-surgery development, in order to know better the pathophysiology of diseases and select better the patients

  15. Enfisema subcutâneo durante inclusão de prótese mamária: relato de caso Enfisema subcutáneo durante inclusión de prótesis mamaria: relato de caso Subcutaneous emphysema during breast augmentation: case report

    Directory of Open Access Journals (Sweden)

    Talita Franco

    2007-08-01

    presencia aislada de enfisema subcutáneo en este tipo de procedimiento. El objetivo de este relato fue resaltar la importancia de un adecuado monitoreo del paciente en el intraoperatorio, de la integración de los miembros del equipo y describir el enfisema subcutáneo, aislado, en paciente sometida a la inclusión de prótesis mamarias. RELATO DEL CASO: Paciente con 27 años, 1,70 m, 54 kg, presentaba hipomastia bilateral, habiendo sido sometida a la inclusión de prótesis mamarias en plan retroglandular. El procedimiento fue realizado bajo anestesia general inhalatoria, asociada a la infiltración de solución anestésica en plan subcutáneo, del área a ser manipulada. Durante la operación se notó crepitación, característica de enfisema subcutáneo, en extensa área anterior del tórax. No hubo alteración en los parámetros de monitoreo de la paciente. La radiografía realizada en el postoperatorio confirmó el cuadro clínico y descartó la incidencia de otras complicaciones. CONCLUSIONES: La incidencia de enfisema subcutáneo durante inclusión de prótesis mamarias puede ser un dato insignificante, pero es importante verificar las condiciones clínicas de la paciente y apartar la posibilidad de neumotórax.BACKGROUND AND OBJECTIVES: Subcutaneous emphysema of the thoracic wall during a surgical procedure with infiltration of local anesthetics may suggest the presence of pneumothorax and its complications. The development of pneumothorax during breast augmentation has already been reported; however, we did not find any reports in the literature on isolated subcutaneous emphysema during this type of procedure. The objective of this report was to emphasize the importance of adequate intraoperative monitoring of the patient, integration of team members, and describe the isolated subcutaneous emphysema in a patient during breast augmentation. CASE REPORT: A 27 years old patient with 1.70 m and 54 kg, with bilateral hypomasty, underwent breast augmentation in a

  16. Prevalence and Effects of Emphysema in Never-Smokers with Rheumatoid Arthritis Interstitial Lung Disease

    Directory of Open Access Journals (Sweden)

    Joseph Jacob

    2018-02-01

    Conclusion: 27% of RA-ILD never-smokers demonstrate emphysema on CT. Emphysema presence in never-smokers independently associates with a definite CT-UIP pattern and a worsened outcome following adjustment for baseline disease severity.

  17. National Emphysema Foundation

    Science.gov (United States)

    ... Navigation Search Javascript is required to use GTranslate multilingual website and translation delivery network Select Language English ... COPD and Emphysema afflict millions of adults and children today. An estimated 3.1 million Americans have ...

  18. The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity.

    LENUS (Irish Health Repository)

    O'Connell, Jean

    2010-01-01

    Several studies have reported the existence of a subgroup of obese individuals with normal metabolic profiles. It remains unclear what factors are responsible for this phenomenon. We proposed that adipocyte size might be a key factor in the protection of metabolically healthy obese (MHO) individuals from the adverse effects of obesity.

  19. Cement dust exposure-related emphysema in a construction worker

    Directory of Open Access Journals (Sweden)

    V Karkhanis

    2011-01-01

    Full Text Available Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

  20. Case Report: Pneumomediastinum and subcutaneous cervical ...

    African Journals Online (AJOL)

    The occurrence of pneumomediastinum and subcutaneous cervical emphysema as complications of childhood pneumonia is very unusual. They results most often from respiratory manoeuvres that produce high intrathoracic pressure. Although they are largely benign, pneumomediastinum can cause compression of major ...

  1. The impact of emphysema in pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Vincent Cottin

    2013-06-01

    Full Text Available Several groups have described a syndrome in which idiopathic pulmonary fibrosis (IPF coexists with pulmonary emphysema. This comes as no surprise since both diseases are associated with a history of exposure to cigarette smoke. The syndrome of combined pulmonary fibrosis and emphysema (CPFE is characterised by upper lobe emphysema and lower lobe fibrosis. Physiological testing of these patients reveals preserved lung volume indices contrasted by markedly impaired diffusion capacity. The incidence of CPFE remains unknown but several case series suggest that this subgroup may comprise up to 35% of patients with IPF. CPFE is a strong determinant of associated pulmonary hypertension (PH. In addition, CPFE has major effects on measures of physiological function, exercise capacity and prognosis, and may affect the results of pulmonary fibrosis trials. Further studies are needed to ascertain the aetiology, morbidity, mortality and management of the CPFE syndrome, with or without PH, and to evaluate novel therapeutic options in CPFE.

  2. A Rare Cause of Lung Emphysema: Neurofibromatosis

    Directory of Open Access Journals (Sweden)

    Rasih Yazkan

    2012-10-01

    Full Text Available Neurofibromatosis (NF is an autosomal dominant inheritance or spontaneous mutation disease. Skin, eyes, central and peripheral nervous system lesions are characteristic. It is evaluated NF type 1 and NF type 2. NF-1 is the most common type of the disease, and described by von Recklinghausen in 1882. Cutaneous and subcutaneous neurofibromas, kyphoscoliosis, rib deformities, thoracic neoplasms, bullous, emphysematous and fibrotic changes could be seen on chest wall and lung parenchyma. We aimed to report this case with a rare cause of lung emph-ysema and the effects of the involvement of the NF-1 to the lung parenchyma.

  3. Subcutaneous NPH Insulin for Severe Hypertriglyceridemia in a Pregnant Patient with Type V Hyperlipoproteinemia: a Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa Kemal Balcı

    2012-06-01

    Full Text Available An increase in triglyceride levels in familial hyperlipidemia during pregnancy has been reported. Severe hypertriglyceridemia can lead to complications such as acute pancreatitis, preeclampsia, maternal and fetal complications. Because of the teratogenic effects associated with fibrate therapy in pregnancy, alternative treatment strategies such as insulin as a rapid and potent activator of lipoprotein lipase are required during pregnancy. We report a case of hypertriglyceridemia in a 33-year-old pregnant woman in whom treatment with merely single one time administration of Neutral Protamine Hagedorn insulin was accompanied by a reduction in the serum triglyceride level; to the best of our knowledge, this has never been reported in the literature. Her triglyceride level was 3616 mg/dL before insulin treatment and 1246 mg/dL after insulin treatment. Although this regimen was used safely and effectively in our patient, comprehensive studies are required to evaluate the effectiveness and safety of subcutaneously intermediate-acting Neutral Protamine Hagedorn insulin for the treatment of severe hypertriglyceridemia in non-diabetic pregnant women.

  4. Enfisema subcutâneo causado por sonda nasofaríngea para administração de oxigênio suplementar: relato de caso Enfisema subcutáneo causado por sonda nasofaríngea para la administración de oxígeno suplementario: relato de caso Subcutaneous emphysema induced by supplementary oxygen delivery nasopharyngeal cannula: case report

    Directory of Open Access Journals (Sweden)

    Juliano Rodrigues Gasparini

    2010-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ocorrência de enfisema subcutâneo atingindo face, pescoço e tórax está bem documentada em casos de procedimentos odontológicos, cirurgia de cabeça e/ou pescoço e trauma craniofacial. Sua ocorrência sem lesão reconhecida das mucosas é rara. Este relato descreve um caso clínico em que o enfisema ocorreu sem uma lesão óbvia. RELATO DO CASO: Paciente do sexo masculino, hígido, submetido a anestesias peridural e local associadas à sedação, para a realização de lipoaspiração de abdome e região submentoniana. Procedimento sem intercorrências até posicionar uma sonda nasofaríngea para administrar oxigênio suplementar. Descreve também uma abordagem alternativa para sua resolução. CONCLUSÕES: Embora raro, o enfisema subcutâneo pode ter graves repercussões. A drenagem linfática manual pode ser uma opção para o tratamento da complicação estéticaJUSTIFICATIVA Y OBJETIVOS: La incidencia del enfisema subcutáneo que llega a la cara, cuello y tórax está bien documentada en casos de procedimientos odontológicos, cirugía de cabeza y/o cuello y trauma craneofacial. Su aparecimiento sin lesión reconocida de las mucosas es raro. Este relato describe un caso clínico en que el enfisema se dio sin una lesión obvia. RELATO DEL CASO: Paciente del sexo masculino, sano, sometido a anestesias epidural y local, asociadas a la sedación para la realización de liposucción de abdomen y de la región submentoniana. Procedimiento sin intercurrencias hasta colocar una sonda nasofaríngea para administrar oxígeno suplementario. También describe un abordaje alternativo para su resolución. CONCLUSIONES: Aunque sea raro, el enfisema subcutáneo a veces puede tener graves consecuencias. El drenaje linfático manual puede ser una opción para el tratamiento de la complicación estéticaBACKGROUND AND OBJECTIVES: The development of subcutaneous emphysema involving face, neck, and thorax has been well

  5. High incidence and severity of injection site reactions in the first cycle compared with subsequent cycles of subcutaneous bortezomib.

    Science.gov (United States)

    Kamimura, Tomohiko; Miyamoto, Toshihiro; Yokota, Noriko; Aoki, Takatoshi; Ito, Yoshikiyo; Akashi, Koichi

    2013-12-01

    Subcutaneous (sc) administration of bortezomib (Bor) has become more common than intravenous (iv) administration in the treatment of multiple myeloma (MM), because scBor results in a lower incidence and severity of peripheral neuropathy and shows efficacy equivalent to ivBor. Bor is an irritant cytotoxic agent when it extravasates from the vasculature. Therefore, it is recommended that sc injections of Bor should be delivered on a rotating basis across eight sites on the abdomen and thighs. Previously, we reported that sc injections of Bor in the abdomen caused fewer grade 2 injection site reactions (ISRs) than those in the thigh. In the present study, we recruited more patients and expanded the scale of our analysis into ISRs following treatment with 300 scBor injections in 20 patients. ISRs of ≥grade 2 were documented in 12 of 109 (11.0 %) thigh injections, but only in three of 191 (1.6 %) abdominal injections (p ISRs of ≥grade 2 occurred more frequently in the first cycle than in the second and subsequent cycles (16.3 vs. 0.91 %, p ISR management, particularly with regard to the first cycle of scBor administration in the thigh. To our knowledge, this is the first report showing that ≥grade 2 ISRs are more common in the first cycle compared with subsequent cycles of scBor in the treatment of MM.

  6. Quantitative analysis of pulmonary emphysema using local binary patterns

    DEFF Research Database (Denmark)

    Sørensen, Lauge Emil Borch Laurs; Shaker, S.B.; de Bruijne, Marleen

    2010-01-01

    We aim at improving quantitative measures of emphysema in computed tomography (CT) images of the lungs. Current standard measures, such as the relative area of emphysema (RA), rely on a single intensity threshold on individual pixels, thus ignoring any interrelations between pixels. Texture...... analysis allows for a much richer representation that also takes the local structure around pixels into account. This paper presents a texture classification-based system for emphysema quantification in CT images. Measures of emphysema severity are obtained by fusing pixel posterior probabilities output.......2% classification accuracy was achieved on a set of 168 manually annotated ROIs, comprising the three classes: normal tissue, centrilobular emphysema, and paraseptal emphysema. The measured emphysema severity was in good agreement with a pulmonary function test (PFT) achieving correlation coefficients of up to |r...

  7. Animal models of pulmonary emphysema: a stereologist's perspective

    Directory of Open Access Journals (Sweden)

    H. Fehrenbach

    2006-12-01

    Full Text Available A variety of animal models have been suggested as models of pulmonary emphysema; these are critically discussed in the present article from a stereologist's perspective. In addition, a stereological design for the quantification of experimentally induced emphysema is proposed. On the basis of the widely accepted definition of pulmonary emphysema being an "abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls," quantitative morphology is the only method with which to reliably assess the presence of emphysema. Recognising this, careful inspection of animal models that are based on instillation of elastase, genetic alterations, inhalation of cigarette smoke or induction of apoptosis, reveals that both criteria of emphysema definition were demonstrated in surprisingly few of them. Several aspects are suggested to be critical for the understanding of animal models of human emphysema. For example, genetic models that rely on the inhibition of the formation of alveoli during post-natal alveolarisation should clearly be distinguished from models that rely on the loss of mature alveoli after alveolarisation is complete. Furthermore, inhalation models that are characterised by exposed animals exhibiting a severe loss of body weight should carefully examine the relative contribution of intervention and weight loss, respectively. Models that rely on the exposure of juvenile animals for several weeks or even months should take into account the effects of normal lung growth and ageing. Stereology offers appropriate tools with which to quantify the parameters relevant to assess development and the regeneration of emphysema. Stereologists continue to develop tools that will help ascertain the reliability of established and new models. If inappropriate parameters continue to be used for the evaluation of animal models of emphysema, thinking and resources are likely to be misdirected and the

  8. Lung volume reduction for emphysema.

    Science.gov (United States)

    Shah, Pallav L; Herth, Felix J; van Geffen, Wouter H; Deslee, Gaetan; Slebos, Dirk-Jan

    2017-02-01

    Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited effects. Surgical resection of the most destroyed sections of the lung can improve pulmonary function and exercise capacity but its benefit is tempered by significant morbidity. This issue stimulated a search for novel approaches to lung volume reduction. Alternative minimally invasive approaches using bronchoscopic techniques including valves, coils, vapour thermal ablation, and sclerosant agents have been at the forefront of these developments. Insertion of endobronchial valves in selected patients could have benefits that are comparable with lung volume reduction surgery. Endobronchial coils might have a role in the treatment of patients with emphysema with severe hyperinflation and less parenchymal destruction. Use of vapour thermal energy or a sclerosant might allow focal treatment but the unpredictability of the inflammatory response limits their current use. In this Review, we aim to summarise clinical trial evidence on lung volume reduction and provide guidance on patient selection for available therapies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Emphysema Is Common in Lungs of Cystic Fibrosis Lung Transplantation Patients: A Histopathological and Computed Tomography Study.

    Directory of Open Access Journals (Sweden)

    Onno M Mets

    Full Text Available Lung disease in cystic fibrosis (CF involves excessive inflammation, repetitive infections and development of bronchiectasis. Recently, literature on emphysema in CF has emerged, which might become an increasingly important disease component due to the increased life expectancy. The purpose of this study was to assess the presence and extent of emphysema in endstage CF lungs.In explanted lungs of 20 CF patients emphysema was semi-quantitatively assessed on histology specimens. Also, emphysema was automatically quantified on pre-transplantation computed tomography (CT using the percentage of voxels below -950 Houndfield Units and was visually scored on CT. The relation between emphysema extent, pre-transplantation lung function and age was determined.All CF patients showed emphysema on histological examination: 3/20 (15% showed mild, 15/20 (75% moderate and 2/20 (10% severe emphysema, defined as 0-20% emphysema, 20-50% emphysema and >50% emphysema in residual lung tissue, respectively. Visually upper lobe bullous emphysema was identified in 13/20 and more diffuse non-bullous emphysema in 18/20. Histology showed a significant correlation to quantified CT emphysema (p = 0.03 and visual emphysema score (p = 0.001. CT and visual emphysema extent were positively correlated with age (p = 0.045 and p = 0.04, respectively.In conclusion, this study both pathologically and radiologically confirms that emphysema is common in end-stage CF lungs, and is age related. Emphysema might become an increasingly important disease component in the aging CF population.

  10. Combined pulmonary fibrosis and emphysema: an increasingly recognized condition

    Directory of Open Access Journals (Sweden)

    Olívia Meira Dias

    2014-06-01

    Full Text Available Combined pulmonary fibrosis and emphysema (CPFE has been increasingly recognized in the literature. Patients with CPFE are usually heavy smokers or former smokers with concomitant lower lobe fibrosis and upper lobe emphysema on chest HRCT scans. They commonly present with severe breathlessness and low DLCO, despite spirometry showing relatively preserved lung volumes. Moderate to severe pulmonary arterial hypertension is common in such patients, who are also at an increased risk of developing lung cancer. Unfortunately, there is currently no effective treatment for CPFE. In this review, we discuss the current knowledge of the pathogenesis, clinical characteristics, and prognostic factors of CPFE. Given that most of the published data on CPFE are based on retrospective analysis, more studies are needed in order to address the role of emphysema and its subtypes; the progression of fibrosis/emphysema and its correlation with inflammation; treatment options; and prognosis.

  11. Hepatocyte and keratinocyte growth factors and their receptors in human lung emphysema

    Directory of Open Access Journals (Sweden)

    Marchal Joëlle

    2005-10-01

    Full Text Available Abstract Background Hepatocyte and keratinocyte growth factors are key growth factors in the process of alveolar repair. We hypothesized that excessive alveolar destruction observed in lung emphysema involves impaired expression of hepatocyte and keratinocyte growth factors or their respective receptors, c-met and keratinocyte growth factor receptor. The aim of our study was to compare the expression of hepatocyte and keratinocyte growth factors and their receptors in lung samples from 3 groups of patients: emphysema; smokers without emphysema and non-smokers without emphysema. Methods Hepatocyte and keratinocyte growth factor proteins were analysed by immunoassay and western blot; mRNA expression was measured by real time quantitative polymerase chain reaction. Results Hepatocyte and keratinocyte growth factors, c-met and keratinocyte growth factor receptor mRNA levels were similar in emphysema and non-emphysema patients. Hepatocyte growth factor mRNA correlated negatively with FEV1 and the FEV1/FVC ratio both in emphysema patients and in smokers with or without emphysema. Hepatocyte and keratinocyte growth factor protein concentrations were similar in all patients' groups. Conclusion The expression of hepatocyte and keratinocyte growth factors and their receptors is preserved in patients with lung emphysema as compared to patients without emphysema. Hepatocyte growth factor mRNA correlates with the severity of airflow obstruction in smokers.

  12. Reproducibility of scoring emphysema by HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Malinen, A.; Partanen, K.; Rytkoenen, H.; Vanninen, R. [Kuopio Univ. Hospital (Finland). Dept. of Clinical Radiology; Erkinjuntti-Pekkanen, R. [Kuopio Univ. Hospital (Finland). Dept. of Pulmonary Diseases

    2002-04-01

    Purpose: We evaluated the reproducibility of three visual scoring methods of emphysema and compared these methods with pulmonary function tests (VC, DLCO, FEV1 and FEV%) among farmer's lung patients and farmers. Material and Methods: Three radiologists examined high-resolution CT images of farmer's lung patients and their matched controls (n=70) for chronic interstitial lung diseases. Intraobserver reproducibility and interobserver variability were assessed for three methods: severity, Sanders' (extent) and Sakai. Pulmonary function tests as spirometry and diffusing capacity were measured. Results: Intraobserver -values for all three methods were good (0.51-0.74). Interobserver varied from 0.35 to 0.72. The Sanders' and the severity methods correlated strongly with pulmonary function tests, especially DLCO and FEV1. Conclusion: The Sanders' method proved to be reliable in evaluating emphysema, in terms of good consistency of interpretation and good correlation with pulmonary function tests.

  13. Reproducibility of scoring emphysema by HRCT

    International Nuclear Information System (INIS)

    Malinen, A.; Partanen, K.; Rytkoenen, H.; Vanninen, R.; Erkinjuntti-Pekkanen, R.

    2002-01-01

    Purpose: We evaluated the reproducibility of three visual scoring methods of emphysema and compared these methods with pulmonary function tests (VC, DLCO, FEV1 and FEV%) among farmer's lung patients and farmers. Material and Methods: Three radiologists examined high-resolution CT images of farmer's lung patients and their matched controls (n=70) for chronic interstitial lung diseases. Intraobserver reproducibility and interobserver variability were assessed for three methods: severity, Sanders' (extent) and Sakai. Pulmonary function tests as spirometry and diffusing capacity were measured. Results: Intraobserver -values for all three methods were good (0.51-0.74). Interobserver varied from 0.35 to 0.72. The Sanders' and the severity methods correlated strongly with pulmonary function tests, especially DLCO and FEV1. Conclusion: The Sanders' method proved to be reliable in evaluating emphysema, in terms of good consistency of interpretation and good correlation with pulmonary function tests

  14. Polymorphism of LRP5 gene and emphysema severity are associated with osteoporosis in Japanese patients with or at risk for COPD.

    Science.gov (United States)

    Chubachi, Shotaro; Nakamura, Hidetoshi; Sasaki, Mamoru; Haraguchi, Mizuha; Miyazaki, Masaki; Takahashi, Saeko; Tanaka, Kyuto; Funatsu, Yohei; Asano, Koichiro; Betsuyaku, Tomoko

    2015-02-01

    Osteoporosis is an important systemic comorbidity of chronic obstructive pulmonary disease (COPD). However, neither its mechanisms nor its risk factors have been fully elucidated. With regard to genetic factors, low-density lipoprotein receptor-related protein 5 (LRP5) A1330V is known to be associated with osteoporosis in the general population, but the influence of this polymorphism in COPD is unknown. The aim of this study was to investigate the potential risk factors of COPD-related bone loss and fracture. Keio University and affiliated hospitals have enrolled an observational cohort to investigate the management of COPD comorbidities. To assess risk factors for osteopenia and osteoporosis, bone mineral density (BMD) of the hip and lumbar spine, presence of vertebral fracture, quantitative data on emphysema and airway wall on computed tomography, as well as LRP5 genotype were analysed in patients with or at risk for COPD (n = 270). The percentage of subjects with osteoporosis (T-score ≤ -2.5), osteopenia (T-score between -1 and -2.5) and a normal BMD (T-score ≥ -1) was 15.2%, 35.9% and 48.9%, respectively. T-score was significantly decreased in subjects with LRP5 TT genotype (n = 15) compared with that in those with CC/CT genotype (n = 255) (-1.83 vs. -0.98, P = 0.0167). On multivariate logistic regression analysis, female gender (odds ratio (OR) 10.4; P LRP5 TT genotype (OR 3.7; P = 0.031) independently increased the risk of osteopenia/osteoporosis. This study confirmed the complex pathophysiology of COPD-related osteoporosis, including the influence of gender, clinical phenotype and genetic factors. © 2014 Asian Pacific Society of Respirology.

  15. Towards exaggerated emphysema stereotypes

    Science.gov (United States)

    Chen, C.; Sørensen, L.; Lauze, F.; Igel, C.; Loog, M.; Feragen, A.; de Bruijne, M.; Nielsen, M.

    2012-03-01

    Classification is widely used in the context of medical image analysis and in order to illustrate the mechanism of a classifier, we introduce the notion of an exaggerated image stereotype based on training data and trained classifier. The stereotype of some image class of interest should emphasize/exaggerate the characteristic patterns in an image class and visualize the information the employed classifier relies on. This is useful for gaining insight into the classification and serves for comparison with the biological models of disease. In this work, we build exaggerated image stereotypes by optimizing an objective function which consists of a discriminative term based on the classification accuracy, and a generative term based on the class distributions. A gradient descent method based on iterated conditional modes (ICM) is employed for optimization. We use this idea with Fisher's linear discriminant rule and assume a multivariate normal distribution for samples within a class. The proposed framework is applied to computed tomography (CT) images of lung tissue with emphysema. The synthesized stereotypes illustrate the exaggerated patterns of lung tissue with emphysema, which is underpinned by three different quantitative evaluation methods.

  16. Emphysema predicts hospitalisation and incident airflow obstruction among older smokers: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    David A McAllister

    Full Text Available Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers.Participants in a lung cancer screening study age ≥ 60 years were recruited into a prospective cohort study in 2001-02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ -910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio <0.70 and FEV1<80% predicted.Of 521 participants, 4% had moderate or severe emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01-3.52 adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19-21.1.Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers.

  17. Panlobular emphysema in young intravenous Ritalin abusers

    International Nuclear Information System (INIS)

    Schmidt, R.A.; Glenny, R.W.; Godwin, J.D.; Hampson, N.B.; Cantino, M.E.; Reichenbach, D.D.

    1991-01-01

    We studied a distinctive group of young intravenous Ritalin abusers with profound obstructive lung disease. Clinically, they seemed to have severe emphysema, but the pathologic basis of their symptoms had not been investigated previously. Seven patients have died and been autopsied: in four, the lungs were fixed, inflated, dried, and examined in detail radiologically, grossly, microscopically, and by electron probe X-ray microanalysis. All seven patients had severe panlobular (panacinar) emphysema that tended to be more severe in the lower lung zones and that was associated with microscopic talc granulomas. Vascular involvement by talc granulomas was variable, but significant interstitial fibrosis was not present. Five patients were tested for alpha-1-antitrypsin deficiency and found to be normal, as were six similar living patients. These findings indicate that some intravenous drug abusers develop emphysema that clinically, radiologically, and pathologically resembles that caused by alpha-1-antitrypsin deficiency but which must have a different pathogenesis. Talc from the Ritalin tablets may be important, but the mechanism remains to be elucidated

  18. Bilateral orbital emphysema and pneumocephalus as a result of accidental compressed air exposure.

    Science.gov (United States)

    Yuksel, Murvet; Yuksel, K Zafer; Ozdemir, Gokhan; Ugur, Tuncay

    2007-01-01

    Orbital emphysema is a rare condition in the absence of trauma or sinus disease. A 22-year-old man suffering from left orbital trauma due to sudden exposure to compressed air tube was admitted with severe pain in the left eye, swelling, and mild periorbital ecchymosis. Physical examination revealed a large conjunctival laceration in the left orbit. Multislice computed tomographic scanning of the head and orbits showed extensive radiolucencies consistent with the air in both orbits, more prominent in the left. There was also subcutaneous air in the left periorbital soft tissue extending through fronto-temporal and zygomatic areas. Air was also demonstrated adjacent to the left optic canal and within the subarachnoid space intracranially. There was no evidence of any orbital, paranasal sinus, or cranial fracture. Visual acuity was minimally decreased bilaterally. The conjunctiva was sutured under local anesthesia. After 3 weeks of follow-up, the patient completely recovered without visual loss. Bilateral orbital emphysema with pneumocephalus can occur from a high-pressure compressed air injury after unilateral conjunctival trauma without any evidence of fracture.

  19. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study.

    NARCIS (Netherlands)

    Fikkers, B.G.; Veen, J.A. van; Kooloos, J.G.M.; Pickkers, P.; Hoogen, F.J.A. van den; Hillen, B.; Hoeven, J.G. van der

    2004-01-01

    STUDY OBJECTIVE: Part 1: To describe cases of emphysema (subcutaneous and/or mediastinal) and pneumothorax after percutaneous dilational tracheostomy (PDT) in a series of 326 patients, and to review the existing literature describing the incidence and possible mechanisms. Part 2: To analyze the

  20. Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema

    Directory of Open Access Journals (Sweden)

    Radwan Kassir

    2014-01-01

    CONCLUSION: This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis.

  1. Towards exaggerated emphysema stereotypes

    DEFF Research Database (Denmark)

    Chen, Chen; Sørensen, Lauge; Lauze, Francois Bernard

    2012-01-01

    We introduce the notion of an exaggerated image stereotype for some image class of interest, which emphasizes/exaggerates the characteristic patterns in an image class and visualizes what visual information the classication relies on. This is useful for gaining insight into the classi cation...... and serves for comparison with thebiological models of disease. We build the exaggerated image stereotypes by optimizing an objective function which consists of a discriminativeterm based on the classi cation accuracy, and a generative term based on the class distribution. Agradient descent method...... is employed for optimization. We use this idea with Fisher's Linear Discriminant rule,and assume a multivariate normal distribution for samples within a class. The proposed framework is appliedto computed tomography (CT) images of lung tissue with emphysema. The synthesized stereotypes illustratethe...

  2. Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers

    Directory of Open Access Journals (Sweden)

    Farrah Kheradmand

    2011-04-01

    Full Text Available Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema, and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7% was detected in 122 (54% subjects. Twenty six (21% emphysema subjects had no evidence of airflow obstruction (FEV1/FVC ratio 23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes.

  3. Proteoglycan changes in the extracellular matrix of lung tissue from patients with pulmonary emphysema

    NARCIS (Netherlands)

    van Straaten, JFM; Coers, W; Noordhoek, JA; Flipsen, JTM; Kauffman, HF; Timens, W; Postma, DS

    To characterize the changes in the extracellular matrix in smoking-related pulmonary emphysema, we undertook immunohistochemical studies in lung tissues from controls (n = 7), from patients with mild (n = 11) and severe (n = 8) emphysema, and from patients with lung fibrosis (n = 6). We studied

  4. Spontaneous Retropharyngeal Emphysema: A Case Report | Chi ...

    African Journals Online (AJOL)

    ... is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema. Keywords: Iatrogenic injury, retropharyngeal emphysema, spontaneous retropharyngeal emphysem, trauma ...

  5. Successful rapid subcutaneous desensitization to anakinra in a case with a severe immediate-type hypersensitivity reaction.

    Science.gov (United States)

    YIlmaz, I; Türk, M; Nazik Bahçecioğlu, S

    2018-03-01

    Anakinra, one of the novel biological agents, is a recombinant human IL-1 receptor antagonist. It is preferred as an alternative drug for familial Mediterranean fever cases where colchicine is not sufficient or cannot be used due to its side effects. Like all other biologics, hypersensitivity reactions to anakinra are quite rare. This is the first case which was successfully desensitized with anakinra after a severe immediate-type hypersensitivity reaction.

  6. Protective effect of Galectin-9 in murine model of lung emphysema: Involvement of neutrophil migration and MMP-9 production

    Science.gov (United States)

    Horio, Yuko; Ichiyasu, Hidenori; Kojima, Keisuke; Saita, Naoki; Migiyama, Yohei; Iriki, Toyohisa; Fujii, Kazuhiko; Niki, Toshiro; Hirashima, Mitsuomi; Kohrogi, Hirotsugu

    2017-01-01

    Purpose Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow obstruction and pulmonary emphysema. Persistent inflammation and remodeling of the lungs and airways result in reduced lung function and a lower quality of life. Galectin (Gal)-9 plays a crucial role as an immune modulator in various diseases. However, its role in the pathogenesis of pulmonary emphysema is unknown. This study investigates whether Gal-9 is involved in pulmonary inflammation and changes in emphysema in a porcine pancreatic elastase (PPE)-induced emphysema model. Materials and methods Gal-9 was administered to mice subcutaneously once daily from 1 day before PPE instillation to day 5. During the development of emphysema, lung tissue and bronchoalveolar lavage fluid (BALF) were collected. Histological and cytological findings, concentrations of chemokines and matrix metalloproteinases (MMPs) in the BALF, and the influence of Gal-9 treatment on neutrophils were analyzed. Results Gal-9 suppressed the pathological changes of PPE-induced emphysema. The mean linear intercept (Lm) of Gal-9-treated emphysema mice was significantly lower than that of PBS-treated emphysema mice (66.1 ± 3.3 μm vs. 118.8 ± 14.8 μm, respectively; p emphysema progressed significantly compared with that in wild–type (WT) mice (108.7 ± 6.58 μm vs. 77.19 ± 6.97 μm, respectively; p emphysema by inhibiting the infiltration of neutrophils and decreasing MMPs levels. Exogenous Gal-9 could be a potential therapeutic agent for COPD. PMID:28704475

  7. Changes in the superior vena cava area during inspiration and expiration in relation to emphysema.

    Science.gov (United States)

    Matsuoka, Shin; Yamashiro, Tsuneo; Kotoku, Akiyuki; Matsushita, Shoichiro; Fujikawa, Atsuko; Yagihashi, Kunihiro; Kurihara, Yasuyuki; Nakajima, Yasuo

    2015-04-01

    In patients with emphysema, increased intrathoracic pressure is closely related to hyperinflation and leads to hemodynamic impairments. Both intrathoracic pressure and hemodynamics such as venous return are affected by the respiratory phase. Therefore, respiratory variations in hemodynamics may be associated with the extent of emphysema that causes increased intrathoracic pressure. The current study was designed to evaluate the relationship between respiratory phasic variations in the area of the superior vena cava (SVC) and the extent of emphysema. We measured the SVC area and calculated the ratio of the SVC area in inspiratory and expiratory scans (i/e-SVC ratio) in 101 patients with emphysema who underwent both inspiratory and expiratory CT. The correlation of the i/e-SVC ratio with the extent of emphysema (%LAA) obtained by CT images was evaluated. Multiple linear regression analysis using i/e-SVC ratio as the dependent variable was performed. The i/e-SVC ratio had a significant positive correlation with%LAA (ρ = 0.582, p <0.0001). The i/e-SVC ratio was significantly higher in patients with severe emphysema (0.86 ± 0.13) than in patients with mild-moderate emphysema (0.69 ± 0.13) (p <0.0001). Multiple linear regression analysis showed that%LAA was the only independent predictors of the i/e-SVC ratio (r(2) = 0.471, p = 0.0006). Respiratory phasic variations in the SVC area are significantly correlated with the extent of emphysema.

  8. Sex-specific features of emphysema among current and former smokers with COPD.

    Science.gov (United States)

    Hardin, Megan; Foreman, Marilyn; Dransfield, Mark T; Hansel, Nadia; Han, MeiLan K; Cho, Michael H; Bhatt, Surya P; Ramsdell, Joe; Lynch, David; Curtis, Jeffrey L; Silverman, Edwin K; Washko, George; DeMeo, Dawn

    2016-01-01

    Recent studies suggest that males with chronic obstructive pulmonary disease (COPD) have more emphysema than females. It is not known if these differences persist across degrees of COPD severity. Our aim was to identify sex-specific differences in quantitative emphysema within COPD subgroups based on COPD severity.We included non-Hispanic white and African-American subjects from the COPDGene study with at least 10 pack-years of smoking and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry grade II or greater. We examined sex-specific differences in log-transformed emphysema (log per cent low-attenuation area (%LAA)) by GOLD spirometry grade among subjects with early-onset COPD (25% emphysema).Compared with females, males had higher log %LAA: overall (1.97±1.4 versus 1.69±1.6, β=0.32 (0.04), p=1.34×10(-14)), and among non-Hispanic white (p=8.37×10(-14)) and African-American subjects (p=0.002). Females with early-onset COPD, severe emphysema and GOLD grade IV COPD had similar emphysema as males, but markedly fewer pack-years smoking (early-onset, p=0.01; severe emphysema and GOLD grade IV, psmokers with COPD who are particularly susceptible to parenchymal destruction. Copyright ©ERS 2016.

  9. Distribution of emphysema in heavy smokers: impact on pulmonary function.

    NARCIS (Netherlands)

    Gietema, H.A.; Zanen, P.; Schilham, A.; Ginneken, B. van; Klaveren, R.J.J. van; Prokop, M.; Lammers, J.W.

    2010-01-01

    PURPOSE: To investigate impact of distribution of computed tomography (CT) emphysema on severity of airflow limitation and gas exchange impairment in current and former heavy smokers participating in a lung cancer screening trial. MATERIALS AND METHODS: In total 875 current and former heavy smokers

  10. Lung volume reduction for emphysema

    NARCIS (Netherlands)

    Shah, Pallav L.; Herth, Felix J.; van Geffen, Wouter H.; Deslee, Gaetan; Slebos, Dirk-Jan

    Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited

  11. Certolizumab pegol, a monthly subcutaneously administered Fc-free anti-TNFalpha, improves health-related quality of life in patients with moderate to severe Crohn's disease.

    Science.gov (United States)

    Rutgeerts, Paul; Schreiber, Stefan; Feagan, Brian; Keininger, Dorothy L; O'Neil, Liz; Fedorak, Richard N

    2008-03-01

    Certolizumab pegol, a polyethylene glycolated Fc-free Fab' was efficacious and well tolerated in patients with moderate-to-severe Crohn's disease in a previously reported randomized, placebo-controlled study. In this paper, we report the effect of certolizumab pegol on health-related quality of life (HRQoL). Patients with moderate-to-severe active Crohn's disease (n = 292) received subcutaneous certolizumab pegol 100, 200, or 400 mg or placebo at weeks 0, 4, and 8. A post hoc analysis of the intent-to-treat population (290 patients with HRQoL data) assessed HRQoL by evaluating patients' responses to the self-administered inflammatory bowel disease questionnaire (IBDQ) at baseline and weeks 2, 4, 6, 8, 10, and 12. Patients receiving certolizumab pegol 400 mg at weeks 0, 4, and 8 demonstrated, via their IBDQ total score, significantly (P severe Crohn's disease.

  12. Persistence of ventilatory defect after resolution of pulmonary interstitial emphysema in a preterm baby.

    Science.gov (United States)

    Filho, Luiz Vicente Ferreira da Silva; Rossi, Felipe De Souza; Deutsch, Alice d'Agostini; Yagui, Ana Cristina Zanon; Timenetsky, Karina; Rebello, Celso de Moura

    2010-07-01

    Pulmonary interstitial emphysema is a common complication of mechanical ventilation in preterm babies. We report a case of severe unilateral pulmonary interstitial emphysema in a premature newborn, treated with high-frequency oscillatory ventilation, lateral decubitus positioning and selective intubation. After complete radiological resolution of the pulmonary emphysema in the left lung, the patient was studied by electrical impedance tomography and a marked reduction of ventilation was identified in the left lung despite radiological resolution of the cysts. This finding indicates that functional abnormalities may persist for longer periods after radiologic resolution of such lesions.

  13. Quantifying emphysema extent from weakly labeled CT scans of the lungs using label proportions learning

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Petersen, Jens; Wille, Mathilde

    2016-01-01

    Quantification of emphysema extent is important in diagnosing and monitoring patients with chronic obstructive pulmonary disease (COPD). Several studies have shown that emphysema quantification by supervised texture classification is more robust and accurate than traditional densitometry. Current...... techniques require highly time consuming manual annotations of patches or use only weak labels indicating overall disease status (e.g, COPD or healthy). We show how visual scoring of regional emphysema extent can be exploited in a learning with label proportions (LLP) framework to both predict presence...... to medical imaging data....

  14. Lung volume reduction surgery for diffuse emphysema.

    Science.gov (United States)

    van Agteren, Joseph Em; Carson, Kristin V; Tiong, Leong Ung; Smith, Brian J

    2016-10-14

    Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to resect damaged emphysematous lung tissue, thereby increasing elastic properties of the lung. This treatment is hypothesised to improve long-term daily functioning and quality of life, although it may be costly and may be associated with risks of morbidity and mortality. Ten years have passed since the last version of this review was prepared, prompting us to perform an update. The objective of this review was to gather all available evidence from randomised controlled trials comparing the effectiveness of lung volume reduction surgery (LVRS) versus non-surgical standard therapy in improving health outcomes for patients with severe diffuse emphysema. Secondary objectives included determining which subgroup of patients benefit from LVRS and for which patients LVRS is contraindicated, to establish the postoperative complications of LVRS and its morbidity and mortality, to determine which surgical approaches for LVRS are most effective and to calculate the cost-effectiveness of LVRS. We identified RCTs by using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register, in addition to the online clinical trials registers. Searches are current to April 2016. We included RCTs that studied the safety and efficacy of LVRS in participants with diffuse emphysema. We excluded studies that investigated giant or bullous emphysema. Two independent review authors assessed trials for inclusion and extracted data. When possible, we combined data from more than one study in a meta-analysis using RevMan 5 software. We identified two new studies (89 participants) in this updated review. A total of 11 studies (1760 participants) met the entry criteria of the review, one of which accounted for 68% of recruited participants. The quality of evidence ranged from low to moderate owing to an unclear risk

  15. Macrophages in lung tissue from patients with pulmonary emphysema express both inducible and endothelial nitric oxide synthase

    NARCIS (Netherlands)

    van Straaten, JFM; Postma, DS; Coers, W; Noordhoek, JA; Kauffman, HF; Timens, W

    To provide information concerning a possible biologic role of nitric oxide (NO) in smoking-related emphysema, we performed immunohistochemical studies in lung tissue from control subjects and patients with mild and severe emphysema We studied the presence of inducible and endothelial NO synthases

  16. Emphysema Distribution and Diffusion Capacity Predict Emphysema Progression in Human Immunodeficiency Virus Infection

    Science.gov (United States)

    Leung, Janice M; Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Scaglioni, Riccardo; Dai, Darlene; Hague, Cameron; Leipsic, Jonathon; Sin, Don D.; Man, SF Paul; Guaraldi, Giovanni

    2016-01-01

    Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ≥2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41–0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93–48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression. PMID:27902753

  17. Emphysema and pulmonary impairment in coal miners: Quantitative relationship with dust exposure and cigarette smoking

    International Nuclear Information System (INIS)

    Kuempel, E D; Vallyathan, V; Green, F H Y

    2009-01-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV 1 , as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV 1 3 x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79).

  18. Emphysema and pulmonary impairment in coal miners: Quantitative relationship with dust exposure and cigarette smoking

    Energy Technology Data Exchange (ETDEWEB)

    Kuempel, E D [National Institute for Occupational Safety and Health, Education and Information Division, Risk Evaluation Branch, Cincinnati, Ohio (United States); Vallyathan, V [National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Pathology and Physiology Research Branch, Morgantown, West Virginia (United States); Green, F H Y, E-mail: ekuempel@cdc.go [Department of Pathology, Faculty of Medicine, University of Calgary, Calgary, Alberta (Canada)

    2009-02-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV{sub 1}, as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV{sub 1} <80% at the cohort mean cumulative coal dust exposure (87 mg/m{sup 3} x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79).

  19. Emphysema and pulmonary impairment in coal miners: quantitative relationship with dust exposure and cigarette smoking

    Energy Technology Data Exchange (ETDEWEB)

    E.D. Kuempel; V. Vallyathan; F.H.Y. Green [National Institute for Occupational Safety and Health, Cincinnati, OH (United States)

    2009-07-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV{sub 1}, as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV1 <80% at the cohort mean cumulative coal dust exposure (87 mg/m{sup 3} x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79). 20 refs., 2 figs., 2 tabs.

  20. Revisiting 'Respiratory Function in Emphysema in Relation to Prognosis'

    Directory of Open Access Journals (Sweden)

    David V Bates

    2000-01-01

    Full Text Available BACKGROUND: The 1956 paper by DV Bates, JMS Knott and RV Christie, "Respiratory function in emphysema in relation to prognosis" Quart J Med 1956;97:137-157 is largely reprinted with a commentary by the first author, Dr David Bates. Although the pathology of emphysema was well recognized at the time, the clinical diagnosis and assessment of its severity were known to be imprecise; physiological measurements assessing and following the clinical course had not been established. The study aimed to follow systematically a group of patients, selected by clinical criteria using standardized clinical and physiological techniques, over four years and correlate physiological and clinical changes in relation to prognosis and eventually to postmortem findings. Fifty-nine patients were recruited to an emphysema clinic at St Bartholomew's Hospital, London, England. Inclusion criteria were dyspnea without other causes and no cor pulmonale present. Patients' symptoms were assessed by a standardized questionnaire, and measurements were taken of lung volumes, maximal ventilatory volume, carbon monoxide diffusing capacity at rest, exercise and oxygen saturation by oximetry.  During the four years of the study, 17 patients died (actuarial expected - four and 13 presented with signs of pulmonary heart failure. All postmortem examinations (n=9 showed advanced emphysema. A seasonal variation in dyspnea was established (the period included the infamous 1952 London smog. Four patients improved, and the remainder were unchanged or deteriorated. Close relationships were shown between dyspnea and function results, particularly for the diffusing capacity of lungs for carbon monoxide (DLCO. A comparison among a group of patients with chronic bronchitis without dyspnea showed that the DLCO discriminated between them. A loss of the normal increase in DLCO during exercise was shown in emphysema.

  1. Determination of the subcutaneous tissue to blood partition coefficient in patients with severe leg ischaemia by a double isotope washout technique

    DEFF Research Database (Denmark)

    Bjerre-Jepsen, K; Faris, I; Henriksen, O

    1982-01-01

    Knowledge of the tissue to blood partition coefficient (lambda) is essential for calculation of the perfusion coefficient in a single tissue based on measurements of the washout of locally injected isotopes. No measurements of lambda for Xenon in subcutaneous tissue in the leg have been done in p...

  2. Fentanyl Sublingual Tablets Versus Subcutaneous Morphine for the Management of Severe Cancer Pain Episodes in Patients Receiving Opioid Treatment: A Double-Blind, Randomized, Noninferiority Trial.

    Science.gov (United States)

    Zecca, Ernesto; Brunelli, Cinzia; Centurioni, Fabio; Manzoni, Andrea; Pigni, Alessandra; Caraceni, Augusto

    2017-03-01

    Purpose Fentanyl sublingual tablets (FST) are a potentially useful alternative to parenteral opioids such as subcutaneous morphine (SCM) to treat severe cancer pain episodes. No direct comparison between FST and SCM is available. The aim of this study was to test noninferiority of FST versus SCM during the first 30 min postadministration. Methods Patients receiving stable opioid therapy and experiencing a severe pain episode were randomly assigned to either 100 µg FST or 5 mg SCM in a double-blind, double-dummy trial. Average pain intensity (PI) assessed on a 0 to 10 numerical rating scale at 10, 20, and 30 min postadministration was the main end point. Analysis of covariance, adjusted by baseline PI, was the main analysis. The noninferiority margin (NIm) for the between-group difference was set at -0.6, that is, equal to one third of the minimum clinically important PI difference of two points. Results A total of 114 patients were randomly assigned to either FST (n = 58) or SCM (n = 56). One patient (in the FST group) withdrew consent before drug administration and was excluded from analysis. Baseline mean PIs were 7.5 in both groups; mean average PIs assessed at 10, 20, and 30 min postadministration were 5.0 and 4.5 for FST and SCM, respectively, with the 95% CI of the between-group difference including the NIm (-0.49; 95% CI, -1.10 to 0.09). Patients taking FST received a second drug dose after 30 min more frequently than did patients taking SCM (51% v 37%, respectively; risk difference, -13%; 95% CI, -30% to 3%). Both treatments were well tolerated, with average follow-up adverse event scores below the response of "A Little." Ninety-three percent of patients preferred the sublingual administration. Conclusion This trial did not show noninferiority of FST versus SCM within the chosen NIm. Both treatments were safe, and patients preferred the sublingual route of administration. FST provides analgesia with modest to moderate increased risk of lower efficacy

  3. Sequential occurrence of combined pulmonary fibrosis and emphysema syndrome in a non-smoker female patient.

    Science.gov (United States)

    Gupta, Pawan; Dash, Devijyoti; Mittal, Richa; Chhabra, Sunil K

    2017-05-01

    The combined pulmonary fibrosis and emphysema (CPFE) syndrome is a unique and an under-recognized disorder characterized by emphysema in the upper lobes and interstitial fibrosis in the lower lobes of the lung. It occurs predominantly in males and almost exclusively in smokers. This rare combination of a restrictive and an obstructive mechanical defect carries a poorer prognosis than either of the two components. We present a case of CPFE syndrome in a non-smoker female patient who developed lower lobe emphysema subsequent to development of interstitial fibrosis. The case was remarkable for the extreme rarity of several presenting features, namely, a lower lobe occurrence of emphysema subsequent to pre-existent interstitial fibrosis, female gender and absence of a history of smoking. © 2015 John Wiley & Sons Ltd.

  4. Quantitative and Qualitative Assessment of Pulmonary Emphysema with T2-Weighted PROPELLER MRI in a High-Risk Population Compared to Low-Dose CT.

    Science.gov (United States)

    Meier-Schroers, Michael; Sprinkart, Alois Martin; Becker, Manuel; Homsi, Rami; Thomas, Daniel

    2018-03-07

     To determine the suitability of T2-weighted PROPELLER MRI for the assessment of pulmonary emphysema.  60 participants in a lung cancer screening program (30 subjects with pulmonary emphysema, and 30 control subjects without emphysema) were included for this retrospective study. All subjects were examined with low-dose CT (LDCT) and MRI within the screening program. The use of a T2-weighted PROPELLER sequence for the assessment of emphysema was analyzed and correlated with the results of LDCT. The presence and the extent of pulmonary emphysema were first assessed qualitatively using a three-point score, and then quantitatively with a semi-automated software program to obtain emphysema indices.  All 30 cases with pulmonary emphysema were accurately detected by MRI. There were 3 cases with emphysema according to MRI without emphysematous changes on LDCT (false-positive results). The qualitative scores as well as the emphysema indices were significantly higher in the emphysema group compared to the control group for MRI and LDCT (p emphysema group and r = 0.668/p emphysema index: r = 0.960/p emphysema group and r = 0.746/p emphysema may be assessed qualitatively and quantitatively by T2-weighted PROPELLER MRI with very good correlation to LDCT.   · T2-weighted PROPELLER MRI may be suitable for the assessment of pulmonary emphysema.. · There was significant correlation between MRI and LDCT regarding qualitative scores and quantitative emphysema indices in our study with correlation coefficients for different subgroups ranging from r = 0.668 to r = 0.960.. · T2-weighted PROPELLER MRI may have the potential to be used for follow-up examinations in patients with severe emphysema to avoid radiation exposure of repeated CTs.. · Meier-Schroers M, Sprinkart AM, Becker M et al. Quantitative and Qualitative Assessment of Pulmonary Emphysema with T2-Weighted PROPELLER MRI in a High-Risk Population Compared to Low-Dose CT. Fortschr R

  5. Systemic and airway inflammation and the presence of emphysema in patients with COPD.

    Science.gov (United States)

    Papaioannou, Andriana I; Mazioti, Argyro; Kiropoulos, Theodoros; Tsilioni, Irini; Koutsokera, Angela; Tanou, Kalliopi; Nikoulis, Dimitrios J; Georgoulias, Panagiotis; Zakynthinos, Epameinondas; Gourgoulianis, Konstantinos I; Kostikas, Konstantinos

    2010-02-01

    The aim of this study was to determine the impact of HRCT-confirmed emphysema on biomarkers evaluating airway and systemic inflammation in COPD patients. Forty-nine consecutive male COPD outpatients with stable COPD were divided in two groups according to the presence or absence of emphysema on HRCT. Patients underwent pulmonary function tests, plus assessment of exercise capacity, body composition and quality of life. Biomarkers were measured in serum (CRP, interleukin-6, TNF-alpha, leptin, adiponectin, osteocalcin, insulin growth factor-1, and systemic oxidative stress), in plasma (fibrinogen and VEGF) and in whole blood (B-type natriuretic peptide). TNF-alpha, 8-isoprostane and pH were additionally measured in exhaled breath condensate. Patients with emphysema had more severe lung function impairment, lower body-mass index and fat-free mass index, and poorer quality of life. Additionally, they presented increased systemic oxidative stress and plasma fibrinogen and lower BNP compared to patients without emphysema. After proper adjustment for disease severity, all differences remained with the exceptions of body-mass index, fat-free mass index and BNP. COPD patients with HRCT-confirmed emphysema present increased systemic oxidative stress and fibrinogen, suggesting that they may be more prone to the systemic consequences of COPD compared to patients without emphysema.

  6. Emphysema following vitrectomy with fluid-gas exchange: description of a rare complication.

    Science.gov (United States)

    Damasceno, Eduardo F; Damasceno, Nadyr; Horowitz, Soraya; Rodrigues, Marcio Mortera

    2014-01-01

    To report a case of subcutaneous emphysema involving the orbit, mediastinum, and face after pars plana vitrectomy with fluid-gas exchange. Case report of a 55-year-old man who presented with bilateral eyelid and face edema and dysphagia in the immediate postoperative period after pars plana vitrectomy. Orbital and chest computed tomographies were performed, revealing emphysema of the orbit and soft tissue of the face, extending from the neck to the upper chest. The patient with a retinal detachment in the right eye underwent 23-gauge vitrectomy surgery with fluid-gas exchange and an implantation of silicone oil. The patient had a previous history of facial trauma for more than 20 years with an orbital fracture. After surgery, the patient developed emphysema of the orbit, soft tissue of the face and upper chest. Systemic prophylactic antibiotics associated with antibiotics and steroid drops performed a satisfactory evolution. The fluid-gas exchange during pars plana vitrectomy in patients with orbital fracture can lead to emphysema of the face, chest, and soft tissue.

  7. Myosin heavy chain and physiological adaptation of the rat diaphragm in elastase-induced emphysema

    Directory of Open Access Journals (Sweden)

    Stedman Hansell H

    2003-02-01

    Full Text Available Abstract Background Several physiological adaptations occur in the respiratory muscles in rodent models of elastase-induced emphysema. Although the contractile properties of the diaphragm are altered in a way that suggests expression of slower isoforms of myosin heavy chain (MHC, it has been difficult to demonstrate a shift in MHCs in an animal model that corresponds to the shift toward slower MHCs seen in human emphysema. Methods We sought to identify MHC and corresponding physiological changes in the diaphragms of rats with elastase-induced emphysema. Nine rats with emphysema and 11 control rats were studied 10 months after instillation with elastase. MHC isoform composition was determined by both reverse transcriptase polymerase chain reaction (RT-PCR and immunocytochemistry by using specific probes able to identify all known adult isoforms. Physiological adaptation was studied on diaphragm strips stimulated in vitro. Results In addition to confirming that emphysematous diaphragm has a decreased fatigability, we identified a significantly longer time-to-peak-tension (63.9 ± 2.7 ms versus 53.9 ± 2.4 ms. At both the RNA (RT-PCR and protein (immunocytochemistry levels, we found a significant decrease in the fastest, MHC isoform (IIb in emphysema. Conclusion This is the first demonstration of MHC shifts and corresponding physiological changes in the diaphragm in an animal model of emphysema. It is established that rodent emphysema, like human emphysema, does result in a physiologically significant shift toward slower diaphragmatic MHC isoforms. In the rat, this occurs at the faster end of the MHC spectrum than in humans.

  8. The extent of emphysema in patients with COPD

    DEFF Research Database (Denmark)

    Shaker, Saher Burhan; Stavngaard, Trine; Hestad, Marianne

    2009-01-01

    measurement and visual and quantitative assessment of CT, from which the relative area of emphysema below -910 Hounsfield units (RA-910) was extracted. RESULTS: Mean RA-910 was 7.4% (n = 5) in patients with GOLD stage I, 17.0% (n = 119) in stage II, 24.2% (n = 79) in stage III and 33.9% (n = 6) in stage IV......BACKGROUND AND AIMS: The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate...... this extent to the GOLD stage of airway obstruction. MATERIALS AND METHODS: We included 209 patients with COPD. COPD was defined as FEV(1)/FVC or=20 pack-years. Patients were assessed by lung function...

  9. Lung volume reduction of pulmonary emphysema: the radiologist task.

    Science.gov (United States)

    Milanese, Gianluca; Silva, Mario; Sverzellati, Nicola

    2016-03-01

    Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist plays a pivotal role in the characterization of parenchymal damage and, thus, assessment of eligibility criteria. This review aims to discuss the most common LVR techniques, namely LVR surgery, endobronchial valves, and coils LVR, with emphasis on the role of computed tomography (CT). Several trials have recently highlighted the importance of regional quantification of emphysema by computerized CT-based segmentation of hyperlucent parenchyma, which is strongly recommended for candidates to any LVR treatment. In particular, emphysema distribution pattern and fissures integrity are evaluated to tailor the choice of the most appropriate LVR technique. Furthermore, a number of CT measures have been tested for the personalization of treatment, according to imaging detected heterogeneity of parenchymal disease. CT characterization of heterogeneous parenchymal abnormalities provides criteria for selection of the preferable treatment in each patient and improves outcome of LVR as reflected by better quality of life, higher exercise tolerance, and lower mortality.

  10. Subcutaneous granuloma annulare: radiologic appearance

    International Nuclear Information System (INIS)

    Kransdorf, M.J.; Murphey, M.D.; Temple, H.T.

    1998-01-01

    Objective. Granuloma annulare is an uncommon benign inflammatory dermatosis characterized by the formation of dermal papules with a tendency to form rings. There are several clinically distinct forms. The subcutaneous form is the most frequently encountered by radiologists, with the lesion presenting as a superficial mass. There are only a few scattered reports of the imaging appearance of this entity in the literature. We report the radiologic appearance of five cases of subcutaneous granuloma annulare. Design and patients. The radiologic images of five patients (three male, two female) with subcutaneous granuloma annulare were retrospectively studied. Mean patient age was 6.4 years (range, 2-13 years). The lesions occurred in the lower leg (two), foot, forearm, and hand. MR images were available for all lesions, gadolinium-enhanced imaging in three cases, radiographs in four, and bone scintigraphy in one. Results. Radiographs showed unmineralized nodular masses localized to the subcutaneous adipose tissue. The size range, in greatest dimension on imaging studies, was 1-4 cm. MR images show a mass with relatively decreased signal intensity on all pulse sequences, with variable but generally relatively well defined margins. There was extensive diffuse enhancement following gadolinium administration. Conclusion. The radiologic appearance of subcutaneous granuloma annulare is characteristic, typically demonstrating a nodular soft-tissue mass involving the subcutaneous adipose tissue. MR images show a mass with relatively decreased signal intensity on all pulse sequences and variable but generally well defined margins. There is extensive diffuse enhancement following gadolinium administration. Radiographs show a soft-tissue mass or soft-tissue swelling without evidence of bone involvement or mineralization. This radiologic appearance in a young individual is highly suggestive of subcutaneous granuloma annulare. (orig.)

  11. Quantifying heterogeneity in emphysema from high-resolution computed tomography: a lung tissue research consortium study.

    Science.gov (United States)

    Yilmaz, Cuneyt; Dane, Dan M; Patel, Nova C; Hsia, Connie C W

    2013-02-01

    To quantify spatial distribution of emphysema using high-resolution computed tomography (HRCT), we applied semiautomated analysis with internal attenuation calibration to measure regional air volume, tissue volume, and fractional tissue volume (FTV = tissue/[air + tissue] volume) in well-characterized patients studied by the Lung Tissue Research Consortium (LTRC). HRCT was obtained at supine end-inspiration and end-expiration, and prone end-inspiration from 31 patients with mild, moderate, severe, or very severe emphysema (stages II-V, forced expiratory volume at 1 second >75%, 51%-75%, 21%-50% and ≤20% predicted, respectively). Control data were from 20 healthy non-smokers (stage I). Each lobe was analyzed separately. Heterogeneity of FTV was assessed from coefficients of variation (CV) within and among lobes, and the kurtosis and skewness of FTV histograms. In emphysema, lobar air volume increased up to 177% above normal except in the right middle lobe. Lobar tissue volume increased up to 107% in mild-moderate stages then normalized in advanced stages. Normally, FTV was up to 82% higher in lower than upper lobes. In mild-moderate emphysema, lobar FTV increased by up to 74% above normal at supine inspiration. In severe emphysema, FTV declined below normal in all lobes and positions in correlation with pulmonary function (P < .05). Markers of FTV heterogeneity increased steadily with disease stage in correlation with pulmonary function (P < .05); the pattern is distinct from that seen in interstitial lung disease (ILD). CT-derived biomarkers differentiate the spatial patterns of emphysema distribution and heterogeneity from that in ILD. Early emphysema is associated with elevated tissue volume and FTV, consistent with hyperemia, inflammation or atelectasis. Published by Elsevier Inc.

  12. Assessment of the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level in patients with emphysema

    International Nuclear Information System (INIS)

    Ley-Zaporozhan, Julia; Ley, Sebastian; Eberhardt, Ralf; Weinheimer, Oliver; Fink, Christian; Puderbach, Michael; Eichinger, Monika; Herth, Felix; Kauczor, Hans-Ulrich

    2007-01-01

    Purpose: To assess the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level using CT and MRI in patients with emphysema. Material and methods: Forty-five patients with severe emphysema (GOLD III and IV) underwent inspiratory 3D-HRCT and contrast-enhanced MR-perfusion (1.5T; 3.5 mm x 1.9 mm x 4 mm). 3D-HRCT data was analyzed using a software for detection and visualization of emphysema. Emphysema was categorized in four clusters with different volumes and presented as overlay on the CT. CT and lung perfusion were visually analyzed for three lobes on each side using a four-point-score to grade the abnormalities on CT (1: predominantly small emphysema-clusters to 4: >75% large emphysema-clusters) and MRI (1: normal perfusion to 4: no perfusion). Results: A total of 270 lobes were evaluated. At CT, the score was 1 for 9 lobes, 2 for 43, 3 for 77, and 4 for 141 lobes. At MRI, the score was 1 for 13 lobes, 2 for 45, 3 for 92, and 4 for 120 lobes. Matching of lung parenchymal destruction and reduced perfusion was found in 213 lobes (weighted kappa = 0.8). The score was higher on CT in 44, and higher on MRI in 13 lobes. Conclusion: 3D-HRCT and 3D MR-perfusion show a high lobar agreement between parenchymal destruction and reduction of perfusion in patients with severe emphysema

  13. Transient severe hypotension with once-weekly subcutaneous injection of teriparatide in osteoporotic patient: a case report and insight for the drug interaction between hypotensive agents and teriparatide.

    Science.gov (United States)

    Enishi, Tetsuya; Uemura, Hirokazu; Katoh, Shinsuke; Inatsugi, Masanori; Minato, Sho; Inatsugi, Kei; Inatsugi, Mikiko; Sato, Nori; Siryo, Koichi

    2015-01-01

    Teriparatide, a recombinant form of parathyroid hormone, were well recognized as a useful option for the treatment of the osteoporosis. Although some side effects of teriparatide include headache, nausea, dizziness, and limb pain were reported. Here we present a 80-year-old woman of transient asymptomatic hypotension with once-weekly subcutaneous injection of teriparatide for the treatment of osteoporosis with hypertension disease as acute-phase reactions. Systolic blood pressure decreased in both 30 min and 60 min after injection compared with before injection. Heart rate increased with passage of time. Statistically significant were observed among before, 30 min, 60 min after injection of teriparatide. Slight nausea was seen as subjective symptoms with the first and second injection after 30 min. This case indicates careful attention, at least 1 hr, was recommended with weekly subcutaneous injections of teriparatide in the treatment for osoteoproteic patient with hypertension decreases. This is a first report, to the best of our knowledge, to demonstrate the transient asymptomatic hypotension after once-weekly injection of teriparatide with hypertension disease. Transient hypotension occurred after injection of teriparatide during the treatment period and was asymptomatic except for the first 2 injections.

  14. Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

    Directory of Open Access Journals (Sweden)

    Watanabe Masahiro

    2012-09-01

    Full Text Available Abstract Introduction Pulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter. Case presentation The baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition. Conclusions Therapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

  15. Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications

    Directory of Open Access Journals (Sweden)

    Jin J

    2018-01-01

    Full Text Available Jianmin Jin,1 Shuling Li,2 Wenling Yu,2 Xiaofang Liu,1 Yongchang Sun1,3 1Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 2Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 3Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China Background: Pulmonary tuberculosis (PTB is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis of COPD with previous PTB have not been studied well.Methods: The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB.Results: A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male were consecutively enrolled. Patients with previous PTB (45.0% had more severe (p=0.045 and longer history (p=0.008 of dyspnea, more exacerbations in the previous year (p=0.011, and more positive culture of P. aeruginosa (p=0.001, compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis (p<0.001, which was more significant in lungs with tuberculosis (TB lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p=0.031, compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle (p=0.001 and lower (p=0.019 lobe emphysema, higher severity score (p=0.028, higher prevalence of panlobular emphysema (p=0.013, and more extensive centrilobular emphysema (p=0.039 were observed. Notably, in patients with

  16. Functional Characterization of a Porcine Emphysema Model

    DEFF Research Database (Denmark)

    Bruun, Camilla Sichlau; Jensen, Louise Kruse; Leifsson, Páll Skuli

    2013-01-01

    phenotypes in humans. Also, the catalytic activities of metalloproteinases (MMPs) are central in the pathogenesis of emphysema/COPD. Especially MMP9, but also MMP2, MMP7, and MMP12 seem to be involved in human emphysema. MMP12−/− mice are protected from smoke-induced emphysema. ITGB6−/− mice spontaneously...... the expression of MMP2, MMP7, MMP9, MMP12, and TGF-β1 by quantitative PCR (qPCR). In addition, immunohistochemical stainings of the lungs with SP-B, SP-C, MMP9, and MMP12 antibodies were performed. The haematologic/immunologic status of the pigs also was studied.The qPCR study showed no difference between pigs...... develop age-related lung emphysema due to lack of ITGB6-TGF-β1 regulation of the MMP12 expression.A mutated pig phenotype characterized by age-related lung emphysema and resembling the ITGB6−/− mouse has been described previously. To investigate the emphysema pathogenesis in this pig model, we examined...

  17. Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Tanabe Naoya

    2012-04-01

    Full Text Available Abstract Background The progression of chronic obstructive pulmonary disease (COPD considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1. However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear. Methods We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA% in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%, and the standard deviation (SD of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined. Results The mean (SD annual change in FEV1 was −44.4 (10.8 mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity. Conclusions A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted

  18. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension.

    Science.gov (United States)

    Huang, Yu-Sen; Hsu, Hsao-Hsun; Chen, Jo-Yu; Tai, Mei-Hwa; Jaw, Fu-Shan; Chang, Yeun-Chung

    2014-01-01

    This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R(2) = 0.340, p = 0.023), RV stroke volume (R(2) = 0.406, p = 0.011), and RV cardiac output (R(2) = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

  19. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension

    International Nuclear Information System (INIS)

    Huang, Yu San; Jaw, Fu Shan; Chen, Jo Yu; Tai, Mei Hwa; Hsu, Hsao Hsun

    2014-01-01

    This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

  20. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Yu San; Jaw, Fu Shan [Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei (China); Chen, Jo Yu; Tai, Mei Hwa [Dept. of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei (China); Hsu, Hsao Hsun [Dept. of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei (China)

    2014-12-15

    This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

  1. Imaging of emphysema; Bildgebung des Lungenemphysems

    Energy Technology Data Exchange (ETDEWEB)

    Grosse, C.; Bankier, A. [Medizinische Universitaet, Institut fuer Radiodiagnostik, Wien (Austria)

    2007-05-15

    Emphysema is defined as a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of the alveolar walls and without obvious fibrosis. It is a very common disease with high morbidity and mortality. Histopathologically, there are two types of emphysema: panlobular emphysema, typically occurring in {alpha}1-antitrypsin deficiency, and centrilobular emphysema, which is strongly associated with cigarette smoking. Computed tomography (CT) allows detection of emphysema with higher sensitivity than conventional chest radiography and pulmonary function tests. CT also allows quantification of emphysema and depicts associated changes and complications. The differential diagnosis of emphysema, which is characterized by the absence of clearly definable walls on CT, includes cystic lung disease, bullae, lung laceration, Langerhans cell histiocytosis, and lymphangioleiomyomatosis -which are all characterized by visible walls on CT. (orig.) [German] Das Lungenemphysem, histologisch definiert als eine abnorme permanente Erweiterung der Luftraeume distal der terminalen Bronchiolen, begleitet von Destruktionen der Alveolarwaende und ohne Zeichen einer wesentlichen Fibrose, ist eine ueberaus haeufige Erkrankung mit hoher Mortalitaet und Morbiditaet. Dem typischerweise beim angeborenen {alpha}1-Antitrypsinmangel angetroffenen panlobulaeren Emphysem steht das haeufigere durch Zigarettenrauchen induzierte zentrilobulaere Emphysem gegenueber. Die Computertomographie (CT) weist im Gegensatz zum konventionellen Roentgen und zu den Lungenfunktionstests eine hohe Sensitivitaet fuer die Detektion des Emphysems auf, ermoeglicht eine Bestimmung des Schweregrads, eine Quantifizierung der emphysematoesen Veraenderungen und weist assoziierte Veraenderungen und Komplikationen nach. Das bildgebend durch das Fehlen klar definierter Raender gekennzeichnete Emphysem ist differenzialdiagnostisch von zystischen

  2. Subcutaneous adipose tissue classification

    Directory of Open Access Journals (Sweden)

    A. Sbarbati

    2010-11-01

    Full Text Available The developments in the technologies based on the use of autologous adipose tissue attracted attention to minor depots as possible sampling areas. Some of those depots have never been studied in detail. The present study was performed on subcutaneous adipose depots sampled in different areas with the aim of explaining their morphology, particularly as far as regards stem niches. The results demonstrated that three different types of white adipose tissue (WAT can be differentiated on the basis of structural and ultrastructural features: deposit WAT (dWAT, structural WAT (sWAT and fibrous WAT (fWAT. dWAT can be found essentially in large fatty depots in the abdominal area (periumbilical. In the dWAT, cells are tightly packed and linked by a weak net of isolated collagen fibers. Collagenic components are very poor, cells are large and few blood vessels are present. The deep portion appears more fibrous then the superficial one. The microcirculation is formed by thin walled capillaries with rare stem niches. Reinforcement pericyte elements are rarely evident. The sWAT is more stromal; it is located in some areas in the limbs and in the hips. The stroma is fairly well represented, with a good vascularity and adequate staminality. Cells are wrapped by a basket of collagen fibers. The fatty depots of the knees and of the trochanteric areas have quite loose meshes. The fWAT has a noteworthy fibrous component and can be found in areas where a severe mechanic stress occurs. Adipocytes have an individual thick fibrous shell. In conclusion, the present study demonstrates evident differences among subcutaneous WAT deposits, thus suggesting that in regenerative procedures based on autologous adipose tissues the sampling area should not be randomly chosen, but it should be oriented by evidence based evaluations. The structural peculiarities of the sWAT, and particularly of its microcirculation, suggest that it could represent a privileged source for

  3. Compressed air blast injury with palpebral, orbital, facial, cervical, and mediastinal emphysema through an eyelid laceration: a case report and review of literature.

    Science.gov (United States)

    Hiraoka, Takahiro; Ogami, Tomohiro; Okamoto, Fumiki; Oshika, Tetsuro

    2013-11-07

    To the best of our knowledge, only 14 cases of orbital or periorbital compressed air injuries from air guns or hoses have been reported in the literature. A 30-year-old man was accidentally injured when a compressed air hose nozzle hit his right eye. The right half of his face was markedly swollen and a skin laceration near the right medial canthus was identified. A computed tomography scan showed subcutaneous and intraorbital emphysema around the right eye as well as cervical and mediastinal emphysema. He was prophylactically treated with systemic and topical antibiotics to prevent infection. All emphysemas had completely resolved 2 weeks after the injury. A review of all 15 cases (including ours) showed that all patients were male and that 6 of the 15 (40.0%) cases were related to industrial accidents. Although emphysema was restricted to the subconjunctival space in 2 (13.3%) cases, it spread to the orbit in the remaining 13 (86.7%) cases. Cervical and mediastinal emphysemas were found in 3 (20.0%) cases, and intracranial emphysema was confirmed in 6 (40.0%) cases. Prophylactic antibiotics were used in most cases and the prognosis was generally good in all but one patient, who developed optic atrophy and blindness.

  4. Is there a role for therapeutic lobectomy for emphysema?

    Science.gov (United States)

    Vaughan, Paul; Oey, Inger; Nakas, Apostolos; Martin-Ucar, Antonio; Edwards, John; Waller, David

    2007-03-01

    The feasibility of performing a standard lobectomy in patients with non-small cell lung cancer (NSCLC) and severe heterogeneous emphysema whose respiratory reserve is outside standard operability guidelines has been described [Edwards JG, Duthie DJR, Waller DA. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Thorax 2001;56:791-5; Korst RJ, Ginsberg RJ, Ailawadi M, Bains MS, Downey RJ, Rusch V, Stover D. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg 1998;66:898-902; Carretta A, Zannini P, Puglisi A, Chiesa G, Vanzulli A, Bianchi A, Fumagalli A, Bianco S. Improvement in pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients. Eur J Cardiothorac Surg 1999;15(5):602-7]. Postoperative lung function was better than predicted, attributable to the therapeutic benefit of deflation of the hemithorax. Our aim was to determine whether the physiological benefits of this approach were superior to conventional non-anatomical lung volume reduction surgery (LVRS) in similar patients. A retrospective review of a single surgeon's experience identified 34 consecutive patients who underwent upper lobectomy for completely resected stage I-II NSCLC, and who had severe heterogeneous emphysema of apical distribution with a predicted postoperative FEV1 of less than 40%. Their perioperative characteristics, postoperative spirometry and survival of these cases were compared to 46 similar patients who underwent unilateral upper lobe LVRS during the same period. Data expressed as median (range). LVRS patients were significantly younger (59 years [39-70] vs 67 years [48-79] pr=-0.33, p=0.02). Lobectomy for lung cancer in patients in severe heterogenous chronic obstructive pulmonary disease is associated with similar improvement in airflow obstruction as conventional LVRS, but is associated with a shorter postoperative course. Lobectomy may

  5. An advanced case of indium lung disease with progressive emphysema.

    Science.gov (United States)

    Nakano, Makiko; Tanaka, Akiyo; Hirata, Miyuki; Kumazoe, Hiroyuki; Wakamatsu, Kentaro; Kamada, Dan; Omae, Kazuyuki

    2016-09-30

    To report the occurrence of an advanced case of indium lung disease with severely progressive emphysema in an indium-exposed worker. A healthy 42-year-old male smoker was employed to primarily grind indium-tin oxide (ITO) target plates, exposing him to indium for 9 years (1998-2008). In 2004, an epidemiological study was conducted on indium-exposed workers at the factory in which he worked. The subject's serum indium concentration (In-S) was 99.7 μg/l, while his serum Krebs von den Lungen-6 level was 2,350 U/ml. Pulmonary function tests showed forced vital capacity (FVC) of 4.17 l (91.5% of the JRS predicted value), forced expiratory volume in 1 s (FEV 1 ) of 3.19 l (80.8% of predicted), and an FEV 1 -to-FVC ratio of 76.5%. A high-resolution chest computed tomography (HRCT) scan showed mild interlobular septal thickening and mild emphysematous changes. In 2008, he was transferred from the ITO grinding workplace to an inspection work section, where indium concentrations in total dusts had a range of 0.001-0.002 mg/m 3 . In 2009, the subject's In-S had increased to 132.1 μg/l, and pulmonary function tests revealed obstructive changes. In addition, HRCT scan showed clear evidence of progressive lung destruction with accompanying severe centrilobular emphysema and interlobular septal thickening in both lung fields. The subject's condition gradually worsened, and in 2015, he was registered with the Japan Organ Transplant Network for lung transplantation (LTx). Heavy indium exposure is a risk factor for emphysema, which can lead to a severity level that requires LTx as the final therapeutic option.

  6. Lung fibroblasts from patients with emphysema show markers of senescence in vitro

    Directory of Open Access Journals (Sweden)

    Nakashima M

    2006-02-01

    Full Text Available Abstract Background The loss of alveolar walls is a hallmark of emphysema. As fibroblasts play an important role in the maintenance of alveolar structure, a change in fibroblast phenotype could be involved in the pathogenesis of this disease. In a previous study we found a reduced in vitro proliferation rate and number of population doublings of parenchymal lung fibroblasts from patients with emphysema and we hypothesized that these findings could be related to a premature cellular aging of these cells. In this study, we therefore compared cellular senescence markers and expression of respective genes between lung fibroblasts from patients with emphysema and control patients without COPD. Methods Primary lung fibroblasts were obtained from 13 patients with moderate to severe lung emphysema (E and 15 controls (C undergoing surgery for lung tumor resection or volume reduction (n = 2. Fibroblasts (8E/9C were stained for senescence-associated β-galactosidase (SA-β-Gal. In independent cultures, DNA from lung fibroblasts (7E/8C was assessed for mean telomere length. Two exploratory 12 k cDNA microarrays were used to assess gene expression in pooled fibroblasts (3E/3C. Subsequently, expression of selected genes was evaluated by quantitative PCR (qPCR in fibroblasts of individual patients (10E/9C and protein concentration was analyzed in the cell culture supernatant. Results The median (quartiles percentage of fibroblasts positive for SA-β-Gal was 4.4 (3.2;4.7 % in controls and 16.0 (10.0;24.8 % in emphysema (p = 0.001, while telomere length was not different. Among the candidates for differentially expressed genes in the array (factor ≥ 3, 15 were upregulated and 121 downregulated in emphysema. qPCR confirmed the upregulation of insulin-like growth factor-binding protein (IGFBP-3 and IGFBP-rP1 (p = 0.029, p = 0.0002, while expression of IGFBP-5, -rP2 (CTGF, -rP4 (Cyr61, FOSL1, LOXL2, OAZ1 and CDK4 was not different between groups. In line with the

  7. Lung ventilation-perfusion imbalance in pulmonary emphysema: assessment with automated V/Q quotient SPECT.

    Science.gov (United States)

    Suga, Kazuyoshi; Kawakami, Yasuhiko; Koike, Hiroaki; Iwanaga, Hideyuki; Tokuda, Osamu; Okada, Munemasa; Matsunaga, Naofumi

    2010-05-01

    Tc-99m-Technegas-MAA single photon emission computed tomography (SPECT)-derived ventilation (V)/perfusion (Q) quotient SPECT was used to assess lung V-Q imbalance in patients with pulmonary emphysema. V/Q quotient SPECT and V/Q profile were automatically built in 38 patients with pulmonary emphysema and 12 controls, and V/Q distribution and V/Q profile parameters were compared. V/Q distribution on V/Q quotient SPECT was correlated with low attenuation areas (LAA) on density-mask computed tomography (CT). Parameters of V/Q profile such as the median, standard deviation (SD), kurtosis and skewness were proposed to objectively evaluate the severity of lung V-Q imbalance. In contrast to uniform V/Q distribution on V/Q quotient SPECT and a sharp peak with symmetrical V/Q distribution on V/Q profile in controls, lung areas showing heterogeneously high or low V/Q and flattened peaks with broadened V/Q distribution were frequently seen in patients with emphysema, including lung areas with only slight LAA. V/Q distribution was also often asymmetric regardless of symmetric LAA. All the proposed parameters of V/Q profile in entire lungs of patients with emphysema showed large variations compared with controls; SD and kurtosis were significantly different from controls (P lungs compared with morphologic CT in patients with emphysema. SD and kurtosis of V/Q profile can be adequate parameters to assess the severity of lung V-Q imbalance causing gas-exchange impairment in patients with emphysema.

  8. Serum Levels of Surfactant Proteins in Patients with Combined Pulmonary Fibrosis and Emphysema (CPFE.

    Directory of Open Access Journals (Sweden)

    Andriana I Papaioannou

    Full Text Available Emphysema and idiopathic pulmonary fibrosis (IPF present either per se or coexist in combined pulmonary fibrosis and emphysema (CPFE. Serum surfactant proteins (SPs A, B, C and D levels may reflect lung damage. We evaluated serum SP levels in healthy controls, emphysema, IPF, and CPFE patients and their associations to disease severity and survival.122 consecutive patients (31 emphysema, 62 IPF, and 29 CPFE and 25 healthy controls underwent PFTs, ABG-measurements, 6MWT and chest HRCT. Serum levels of SPs were measured. Patients were followed-up for 1-year.SP-A and SP-D levels differed between groups (p = 0.006 and p<0.001 respectively. In post-hoc analysis, SP-A levels differed only between controls and CPFE (p<0.05 and CPFE and emphysema (p<0.05. SP-D differed between controls and IPF or CPFE (p<0.001 for both comparisons. In IPF SP-B correlated to pulmonary function while SP-A, correlated to the Composite Physiological Index (CPI. Controls current smokers had higher SP-A and SP-D levels compared to non-smokers (p = 0.026 and p = 0.023 respectively. SP-D levels were higher in CPFE patients with extended emphysema (p = 0.042. In patients with IPF, SP-B levels at the upper quartile of its range (≥26 ng/mL presented a weak association with reduced survival (p = 0.05.In conclusion, serum SP-A and SP-D levels were higher where fibrosis exists or coexists and related to disease severity, suggesting that serum SPs relate to alveolar damage in fibrotic lungs and may reflect either local overproduction or overleakage. The weak association between high levels of SP-B and survival needs further validation in clinical trials.

  9. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.

    Science.gov (United States)

    Kawut, Steven M; Poor, Hooman D; Parikh, Megha A; Hueper, Katja; Smith, Benjamin M; Bluemke, David A; Lima, João A C; Prince, Martin R; Hoffman, Eric A; Austin, John H M; Vogel-Claussen, Jens; Barr, R Graham

    2014-11-11

    The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago. This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging. We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions <-950 Hounsfield units on full-lung computed tomography; emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea. Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p < 0.001). RV mass and ejection fraction were similar between the groups. A greater percentage of emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p < 0.001), as was the presence of centrilobular and paraseptal emphysema. RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. CT analysis of lung cancer and coexistent emphysema

    International Nuclear Information System (INIS)

    Noh, Kyung Hee; Chung, Myung Hee; Sung, Mi Sook; Yoo, Won Jong; Son, Kyung Myung; Son, Jung Min; Park, Seog Hee

    2004-01-01

    To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p= 0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT

  11. Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Jovaisa Tomas

    2011-06-01

    Full Text Available Abstract Introduction Pulmonary interstitial emphysema is a life-threatening form of ventilator-induced lung injury. We present one of the few reported adult cases of pulmonary interstitial emphysema in a woman with respiratory failure admitted to our intensive care unit. Case presentation An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilateral alveolar/interstitial infiltrates on a chest radiograph fulfilled the criteria for adult respiratory distress syndrome; the cause was thought to be a combination of the direct pneumonic pulmonary injury and extrapulmonary severe sepsis. By day seven, the fraction of inspired oxygen, peak airway and positive end expiratory pressures weaned sufficiently to allow an uncomplicated percutaneous tracheostomy. On day 10, problems with ventilation necessitated recruitment maneuvers with a Mapleson C circuit, after which dramatic surgical emphysema was noted. An upper airway bronchoscopy showed no obvious tracheal wall injury, and computed tomography of her chest showed extensive surgical emphysema, perivascular emphysema and peribronchial emphysema, which were consistent with a diagnosis of pulmonary interstitial emphysema. Over the following days, despite protective ventilatory strategies and intercostal tube thoracostomy, lung compliance along with oxygenation deteriorated and our patient died on day 14. Conclusion The development of pulmonary interstitial emphysema is a rare but real risk when caring for patients with worsening lung compliance on the intensive care unit. Improved awareness of the condition, early protective ventilation strategies and timely treatment of any of the lethal complications will hopefully result in improved survival from the condition in adults.

  12. Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature

    Science.gov (United States)

    2011-01-01

    Introduction Pulmonary interstitial emphysema is a life-threatening form of ventilator-induced lung injury. We present one of the few reported adult cases of pulmonary interstitial emphysema in a woman with respiratory failure admitted to our intensive care unit. Case presentation An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilateral alveolar/interstitial infiltrates on a chest radiograph fulfilled the criteria for adult respiratory distress syndrome; the cause was thought to be a combination of the direct pneumonic pulmonary injury and extrapulmonary severe sepsis. By day seven, the fraction of inspired oxygen, peak airway and positive end expiratory pressures weaned sufficiently to allow an uncomplicated percutaneous tracheostomy. On day 10, problems with ventilation necessitated recruitment maneuvers with a Mapleson C circuit, after which dramatic surgical emphysema was noted. An upper airway bronchoscopy showed no obvious tracheal wall injury, and computed tomography of her chest showed extensive surgical emphysema, perivascular emphysema and peribronchial emphysema, which were consistent with a diagnosis of pulmonary interstitial emphysema. Over the following days, despite protective ventilatory strategies and intercostal tube thoracostomy, lung compliance along with oxygenation deteriorated and our patient died on day 14. Conclusion The development of pulmonary interstitial emphysema is a rare but real risk when caring for patients with worsening lung compliance on the intensive care unit. Improved awareness of the condition, early protective ventilation strategies and timely treatment of any of the lethal complications will hopefully result in improved survival from the condition in adults. PMID:21702976

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

    NARCIS (Netherlands)

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

    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

  14. Congenital lobar emphysema: Is surgery routinely necessary ...

    African Journals Online (AJOL)

    Congenital lobar emphysema (CLE) is a rare congenital abnormality characterised by overinflation of a pulmonary lobe. Its aetiology is unknown. The management of CLE has traditionally been surgical. A newborn boy with a birthweight of 2.5 kg was delivered at full-term by caesarian section due to food delivery.

  15. Emphysema. Imaging for endoscopic lung volume reduction

    International Nuclear Information System (INIS)

    Storbeck, B.; Oldigs, M.; Rabe, K.F.; Weber, C.; University Medical Center Hamburg-Eppendorf

    2015-01-01

    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.

  16. Heme oxygenase-1 attenuates inflammation and oxidative damage in a rat model of smoke-induced emphysema.

    Science.gov (United States)

    Wei, Jingjing; Fan, Guoquan; Zhao, Hui; Li, Jianqiang

    2015-11-01

    Emphysema is a serious disease of the respiratory system and is associated with inflammation and oxidative stress. Heme oxygenase-1 (HO-1), a rate-limiting enzyme involved in heme biosynthesis, exerts potent anti-inflammatory, antioxidant, anti-apoptotic and anti‑proliferative effects in various diseases. In the present study, we examined the effects of HO-1 on smoke‑induced emphysema, as well as the underlying mechanisms in a rat model of smoke-induced emphysema. Rats were either exposed to cigarette smoke or sham‑exposed for 20 weeks to establish the model of smoke-induced emphysema. The rats were subcutaneously injected with protoporphyrin IX [tin-protoporphyrin IX (SnPP) or ferriprotoporphyrin IX chloride (hemin)] during this period to examine the protective effects of HO-1. Subsequently, the development of emphysema, inflammatory cells, the levels of inflammatory mediators, particularly interleukin (IL)-17, tumor necrosis factor (TNF)‑α, monocyte chemotactic protein‑1 [MCP‑1, also known as chemokine (C-C motif) ligand 2 (CCL2)], IL-8 [also known as chemokine (C-X-C motif) ligand 8 (CXCL8)], macrophage inflammatory protein‑2α [MIP-2α, also known as chemokine (C-X-C motif) ligand 2 (CXCL2)] and IL-10, as well as the malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) content were determined. Exposure to smoke increased the total cell, neutrophil and macrophage counts in the bronchoalveolar lavage fluid (BALF). It also increased the levels of the inflammatory mediators, IL-17, TNF-α, MCP-1, IL-8 and MIP-2α, as well as the MDA content and induced emphysema. Treatment with hemin upregulated HO-1 expression and attenuated the development of smoke-induced emphysema by reducing inflammatory cell infiltration, decreasing the levels of inflammatory mediators and attenuating oxidative damage, to a certain extent. In conclusion, our findings demonstrate that HO-1 exerts anti-inflammatory and antioxidant effects, thus attenuating the

  17. Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study.

    Science.gov (United States)

    Hueper, Katja; Vogel-Claussen, Jens; Parikh, Megha A; Austin, John H M; Bluemke, David A; Carr, James; Choi, Jiwoong; Goldstein, Thomas A; Gomes, Antoinette S; Hoffman, Eric A; Kawut, Steven M; Lima, Joao; Michos, Erin D; Post, Wendy S; Po, Ming Jack; Prince, Martin R; Liu, Kiang; Rabinowitz, Dan; Skrok, Jan; Smith, Ben M; Watson, Karol; Yin, Youbing; Zambeli-Ljepovic, Alan M; Barr, R Graham

    2015-09-01

    Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below -950 Hounsfield units (-950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.

  18. Pneumomediastinum from a severe asthma attack.

    Science.gov (United States)

    Hashim, Taimoor; Chaudry, Ayesha H; Ahmad, Khurram; Imhoff, Jennifer; Khouzam, Rami

    2013-07-01

    Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

  19. Subcutaneous implants of polypropylene filaments.

    Science.gov (United States)

    Liebert, T C; Chartoff, R P; Cosgrove, S L; McCuskey, R S

    1976-11-01

    Extruded filaments of unmodified polypropylene (PP) with and without antioxidant were implanted subcutaneously in hamsters in order to determine their rate of degradation. Specimens were removed periodically during a 5 month test period and analyzed by infrared spectroscopy and dynamic mechanical testing. The analyses show that degradation beigns to occur after only a few days. Although the reaction sequence is not known, several factors suggest that the in vivo degradation process is similar to autoxidation which occurs in air or oxygen. The infrared data indicate that the hydroxyl content of the implants increases at a rate of 0.061 mg/g polypropylene per day during the initiation phase of the reaction. An induction time of 108 days was extablished. Carbonyl bonds appear after an implantation time of 50--90 days and increase therafter. Mechanical tests indicate a decrease in the dynamic loss tangent, tan delta, during the first month of implantation for unmodified polypropylene. No change in the infrared spectra or tan delta was observed, however, for implants containing an antioxidant. Thus, it is apparent that polypropylene filaments implanted subcutaneously in hamsters degrade by an oxidation process which is retarded effectively by using an antioxidant. While the findings reported are specific to subcutaneous polypropylene implants, they suggest that degradation of other systems may involve similar processes. This notion suggests directions for further research on increasing the in vivo stability of synthetic polymers. Long-term effects of polymer implantation upon tissue were not studied in this work.

  20. Sub-Volumetric Classification and Visualization of Emphysema Using a Multi-Threshold Method and Neural Network

    Science.gov (United States)

    Tan, Kok Liang; Tanaka, Toshiyuki; Nakamura, Hidetoshi; Shirahata, Toru; Sugiura, Hiroaki

    Chronic Obstructive Pulmonary Disease is a disease in which the airways and tiny air sacs (alveoli) inside the lung are partially obstructed or destroyed. Emphysema is what occurs as more and more of the walls between air sacs get destroyed. The goal of this paper is to produce a more practical emphysema-quantification algorithm that has higher correlation with the parameters of pulmonary function tests compared to classical methods. The use of the threshold range from approximately -900 Hounsfield Unit to -990 Hounsfield Unit for extracting emphysema from CT has been reported in many papers. From our experiments, we realize that a threshold which is optimal for a particular CT data set might not be optimal for other CT data sets due to the subtle radiographic variations in the CT images. Consequently, we propose a multi-threshold method that utilizes ten thresholds between and including -900 Hounsfield Unit and -990 Hounsfield Unit for identifying the different potential emphysematous regions in the lung. Subsequently, we divide the lung into eight sub-volumes. From each sub-volume, we calculate the ratio of the voxels with the intensity below a certain threshold. The respective ratios of the voxels below the ten thresholds are employed as the features for classifying the sub-volumes into four emphysema severity classes. Neural network is used as the classifier. The neural network is trained using 80 training sub-volumes. The performance of the classifier is assessed by classifying 248 test sub-volumes of the lung obtained from 31 subjects. Actual diagnoses of the sub-volumes are hand-annotated and consensus-classified by radiologists. The four-class classification accuracy of the proposed method is 89.82%. The sub-volumetric classification results produced in this study encompass not only the information of emphysema severity but also the distribution of emphysema severity from the top to the bottom of the lung. We hypothesize that besides emphysema severity, the

  1. Subcutaneous encapsulated fat necrosis

    DEFF Research Database (Denmark)

    Aydin, Dogu; Berg, Jais O

    2016-01-01

    We have described subcutaneous encapsulated fat necrosis, which is benign, usually asymptomatic and underreported. Images have only been published on two earlier occasions, in which the necrotic nodules appear "pearly" than the cloudy yellow surface in present case. The presented image may help f...

  2. A case of subcutaneous zygomycosis

    Directory of Open Access Journals (Sweden)

    Usha Rani Anaparthy

    2014-01-01

    Full Text Available Zygomycosis is an acute or chronic infection caused by several fungal agents belonging to the phylum Zygomycota. These are saprophytic fungi and are found ubiquitously in the environment. These are emerging highly opportunistic pathogenic organisms. Basidiobolus ranarum (B. haptosporus, B. meristoporus is a fungus belonging to the order Entomophthorales under the family Zygomycota. Basidiobolomycosis is a predominantly subcutaneous infection involving the trunk and limbs in immunocompetent hosts. We hereby report a case of Basidiobolomycosis from the Department of Microbiology, Siddhartha Medical College, Vijayawada in a 6 month old child who presented to us with a painless swelling over her left knee following an insect bite.

  3. Congenital lobar emphysema: Is surgery routinely necessary?

    Directory of Open Access Journals (Sweden)

    Bulut Ismet

    2010-01-01

    Full Text Available Congenital lobar emphysema (CLE is a rare congenital abnormality characterised by overinflation of a pulmonary lobe. Its aetiology is unknown. The management of CLE has traditionally been surgical. A newborn boy with a birthweight of 2.5 kg was delivered at full-term by caesarian section due to food delivery. There was no marked respiratory distress at birth, and little meconium stained liquor was seen on the skin. The initial diagnosis was meconium aspiration syndrome. After computed tomography of the thorax, CLE was diagnosed. The patient was observed throughout for a week and the CT of the thorax was repeated, which revealed that the emphysema had resolved. The nonoperative approach should be considered in asymptomatic patients with CLE.

  4. Correlation of emphysema score with perceived malignancy of pulmonary nodules: a multi-observer study using the LIDC-IDRI CT lung database

    Science.gov (United States)

    Wiemker, Rafael; Bülow, Thomas; Blaffert, Thomas; Dharaiya, Ekta

    2009-02-01

    Presence of emphysema is recognized to be one of the single most significant risk factors in risk models for the prediction of lung cancer. Therefore, an automatically computed emphysema score would be a prime candidate as an additional numerical feature for computer aided diagnosis (CADx) for indeterminate pulmonary nodules. We have applied several histogram-based emphysema scores to 460 thoracic CT scans from the IDRI CT lung image database, and analyzed the emphysema scores in conjunction with 3000 nodule malignancy ratings of 1232 pulmonary nodules made by expert observers. Despite the emphysema being a known risk factor, we have not found any impact on the readers' malignancy rating of nodules found in a patient with higher emphysema score. We have also not found any correlation between the number of expert-detected nodules in a patient and his emphysema score, or the relative craniocaudal location of the nodules and their malignancy rating. The inter-observer agreement of the expert ratings was excellent on nodule diameter (as derived from manual delineations), good for calcification, and only modest for malignancy and shape descriptions such as spiculation, lobulation, margin, etc.

  5. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.

    Science.gov (United States)

    Warren, Richard B; Mrowietz, Ulrich; von Kiedrowski, Ralph; Niesmann, Johannes; Wilsmann-Theis, Dagmar; Ghoreschi, Kamran; Zschocke, Ina; Falk, Thomas M; Blödorn-Schlicht, Norbert; Reich, Kristian

    2017-02-04

    Methotrexate is one of the most commonly used systemic drugs for the treatment of moderate to severe psoriasis; however, high-quality evidence for its use is sparse and limited to use of oral dosing. We aimed to assess the effect of an intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis. We did this prospective, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial (METOP) at 16 sites in Germany, France, the Netherlands, and the UK. Eligible patients were aged 18 years or older, had a diagnosis of chronic plaque psoriasis for at least 6 months before baseline, had currently moderate to severe disease, and were methotrexate treatment-naive. Participants were randomly assigned (3:1), via a computer-generated random number sequence integrated into an electronic data capture system, to receive either methotrexate at a starting dose of 17·5 mg/week or placebo for the first 16 weeks, followed by methotrexate treatment of all patients up to 52 weeks (methotrexate-methotrexate vs placebo-methotrexate groups). Dose escalation to 22·5 mg/week was allowed after 8 weeks of methotrexate treatment if patients had not achieved at least a 50% reduction in baseline Psoriasis Area and Severity Index score (PASI), with corresponding volume increases in placebo injections. Treatment was combined with folic acid 5 mg/week. Group allocation was concealed from participants and investigators from the time of randomisation until an interim database lock at week 16, and was open label from week 16 onwards, with no masking of participants or investigators. The primary efficacy endpoint was a 75% reduction in PASI score (PASI 75) from baseline to week 16. We did analysis by modified intention to treat, with non-responder imputation. This study is registered with EudraCT, number 2012-002716-10. Between Feb 22, 2013, and May 13, 2015, we randomly assigned 120 patients to receive methotrexate (n=91) or placebo (n

  6. Congenital lobar emphysema in neonates: Anaesthetic challenges

    Directory of Open Access Journals (Sweden)

    Mridu Paban Nath

    2011-01-01

    Full Text Available Congenital lobar emphysema (CLE is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.

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

    Science.gov (United States)

    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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Assessment of the relationship between morphological emphysema phenotype and corresponding pulmonary perfusion pattern on a segmental level

    Energy Technology Data Exchange (ETDEWEB)

    Bryant, Mark; Kauczor, Hans-Ulrich [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Member of German Lung Research Center DZL, Translational Lung Research Center TLRC-H, Heidelberg (Germany); Ley, Sebastian [Chirurgische Klinik Dr. Rinecker, Department of Diagnostic and Interventional Radiology, Munich (Germany); Ludwig Maximilians University, Department of Clinical Radiology, Munich (Germany); Eberhardt, Ralf; Herth, Felix [Thoraxklinik University of Heidelberg, Department of Pneumology and Critical Care Medicine, Heidelberg (Germany); Member of German Lung Research Center DZL, Translational Lung Research Center TLRC-H, Heidelberg (Germany); Menezes, Ravi [University of Toronto, Medical Imaging, Toronto (Canada); Sedlaczek, Oliver [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); German Cancer Research Center, Department of Radiology, Heidelberg (Germany); Member of German Lung Research Center DZL, Translational Lung Research Center TLRC-H, Heidelberg (Germany); Ley-Zaporozhan, Julia [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Ludwig Maximilians University, Department of Clinical Radiology, Munich (Germany)

    2015-01-15

    Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns. Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage. 730 segments were evaluated. CT categorized 566 (78 %) as centrilobular, 159 (22 %) as panlobular and 5 (<1 %) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1-0; 2-0; 3-28 (4 %); 4-425 (58 %); 5-169 (23 %); 6-108 (15 %). The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42 % panlobular - homogeneous absence of perfusion (score 5); and 43 % panlobular - heterogeneous absence of perfusion (score 6). MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema. (orig.)

  9. Subcutaneous bronchogenic cyst

    Directory of Open Access Journals (Sweden)

    Vivek Manchanda

    2010-01-01

    Full Text Available Bronchogenic cysts occur due to the anomalous development of the primitive tracheobronchial tree early in fetal life. They are usually present in middle mediastinum. Rarely, they have been found in other locations. We describe two patients with subcutaneous bronchogenic cysts located over manubrium sterni with special emphasis on the difficulties in pre-operative diagnosis. The two boys were managed by complete excision of the cysts. The children are well on follow-up.

  10. Lung emphysema induced by cigarette smoke: Studies in mice

    NARCIS (Netherlands)

    Eijl, Teunis Jan Ahasuerus van

    2006-01-01

    The experiments described in this thesis were designed to shed some more light on the mechanisms underlying cigarette smoke-induced lung emphysema. We used elastase instillation to induce lung emphysema, and subsequently perfused the lungs ex-vivo with buffer at a range of flows to measure changes

  11. Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion.

    LENUS (Irish Health Repository)

    Thakral, R

    2011-06-01

    Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.

  12. The implications of pneumomediastinum and subcutaneous emphysema for the paediatric otolaryngologist.

    Science.gov (United States)

    Swords, Chloe; Tan, Neil Cheng-Wen; Jonas, Nico

    2017-10-01

    Three patients presented within a 6-month period with pneumomediastinum. The underlying cause in each was distinct. One case occurred due to blunt laryngeal trauma and required urgent surgical intervention due to a decompensating airway. The second case was related to tracheal perforation secondary to a myofibroblastic tracheal tumour and the final case was related to adenovirus upper respiratory tract infection. Pneumomediastinum may be spontaneous or secondary to an underlying cause. Children should be managed using a multidisciplinary approach. Investigation and management should be influenced by clinical stability and invasive procedures should only be considered in patients who exhibit respiratory distress. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  13. Severe paraquat poisoning: clinical and radiological findings in a survivor

    International Nuclear Information System (INIS)

    Neves, Fabio Fernandes; Sousa, Romualdo Barroso; Pazin-Filho, Antonio; Cupo, Palmira; Elias Junior, Jorge; Nogueira-Barbosa, Marcello Henrique

    2010-01-01

    Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning. (author)

  14. Severe paraquat poisoning: clinical and radiological findings in a survivor

    Energy Technology Data Exchange (ETDEWEB)

    Neves, Fabio Fernandes; Sousa, Romualdo Barroso; Pazin-Filho, Antonio; Cupo, Palmira; Elias Junior, Jorge; Nogueira-Barbosa, Marcello Henrique, E-mail: fabioneves@hcrp.usp.b [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Medical School

    2010-07-01

    Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning. (author)

  15. Surgical Outcomes of Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema and Those with Idiopathic Pulmonary Fibrosis without Emphysema.

    Science.gov (United States)

    Sato, Seijiro; Koike, Terumoto; Hashimoto, Takehisa; Ishikawa, Hiroyuki; Okada, Akira; Watanabe, Takehiro; Tsuchida, Masanori

    2016-08-23

    Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder. The aim of this study was to compare the surgical outcomes of lung cancer patients with CPFE and those with idiopathic pulmonary fibrosis (IPF) without emphysema. A total of 1548 patients who underwent surgery for primary lung cancer between January 2001 and December 2012 were retrospectively reviewed. Of the 1548 patients, 55 (3.6%) had CPFE on computed tomography (CT), and 45 (2.9%) had IPF without emphysema. The overall and disease-free 5-year survival rates for patients with CPFE were not significantly worse than those for patients with IPF without emphysema (24.9% vs. 36.8%, p = 0.814; 39.8% vs. 39.3%, p = 0.653, respectively). Overall, 21 (38.1%) patients with CPFE and nine patients (20.0%) with IPF without emphysema developed postoperative cardiopulmonary complications. Patients with CPFE had significantly more postoperative cardiopulmonary complications involving pulmonary air leakage for >6 days, hypoxemia, and arrhythmia than patients with IPF without emphysema (p = 0.048). There was no significant difference in survival after surgical treatment between CPFE patients and IPF patients without emphysema, but CPFE patients had significantly higher morbidity than IPF patients without emphysema.

  16. [Subcutaneous phaeohyphomycosis caused by Phaeoacremonium parasiticum].

    Science.gov (United States)

    Alayeto Ortega, Jose; Alier Fabregó, Albert; Puig Verdie, Lluis; Sorli Redo, Maria Luisa; Horcajada Gallego, Juan Pablo; Portillo Bordonabe, M Eugenia

    2015-01-01

    From the available literature, it is demonstrated that dematiaceous fungal infections mostly affect immunosuppressed patients. These infections can occur in different forms, from subcutaneous infection to disseminated forms that may compromise the life of the patient. In many cases the infection is related to the inoculation of the microorganism by diverse traumatic mechanisms, which determines the course of the infection to be slower in some cases. We describe two cases of phaeohyphomycosis caused by Phaeoacremonium parasiticum: A cancer patient with subcutaneous lesions affecting the left hand and forearm, and a patient who presented with subcutaneous abscesses in the left leg. These cases confirm the presence of this type of fungus in Spain. In the second case a combination of amphotericin B lipid complex and posaconazole, together with several surgical resections, were necessary in order to overcome the infection. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  17. Influence of emphysema distribution on pulmonary function parameters in COPD patients

    Directory of Open Access Journals (Sweden)

    Helder Novais e Bastos

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. METHODS: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT and determined the six-minute walk distance (6MWD. RESULTS: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years. The emphysema distribution was categorized as obviously upper lung-predominant (type 1, in 36.0% of the patients; slightly upper lung-predominant (type 2, in 25.6%; homogeneous between the upper and lower lung (type 3, in 16.3%; and slightly lower lung-predominant (type 4, in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 < 65% of the predicted value (OR = 6.91, 95% CI: 1.43-33.45; p = 0.016, a 6MWD < 350 m (OR = 6.36, 95% CI: 1.26-32.18; p = 0.025, and post-6MWT hypoxemia (OR = 32.66, 95% CI: 3.26-326.84; p = 0.003. The type 3 patients had a higher RV/TLC ratio, although the difference was not significant. CONCLUSIONS: The severity of COPD appears to be greater in type 4 patients, and type 3 patients tend to have greater hyperinflation. The distribution of emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients.

  18. Subcutaneous fibrosis after whole neck irradiation

    International Nuclear Information System (INIS)

    Hirota, Saeko; Tsujino, Kayoko; Oshitani, Takashi; Hishikawa, Yoshio; Takada, Yoshiki; Kono, Michio; Abe, Mitsuyuki

    2002-01-01

    Purpose: To identify the risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. Methods and Materials: We analyzed 233 cases of patients who had undergone whole neck irradiation with 4-MV X-ray or 8-10-MeV electrons, or both, and had been followed with regard to their skin condition for at least 1 year. The prescribed dose to the whole neck ranged from 19.2 to 72.4 Gy (median 50). The skin-absorbed dose was specified as that at a depth of 4.1 mm (d4.1-mm depth ), and a biologically equivalent dose (BED) of d4.1-mm depth was also estimated (BED 1.8 4.1-mm depth ). Results: Univariate analysis revealed that previous neck dissection, concurrent chemotherapy, corticosteroid administration as a part of chemotherapy, fractionation, and BED 1.8 4.1-mm depth were significant prognostic variables. Multivariate analysis showed that BED 1.8 4.1-mm depth and previous neck dissection were the only prognostic variables for moderate to severe subcutaneous fibrosis. Conclusion: A high dose to a 4.1-mm depth of the skin and a history of neck dissection were identified as the predominant risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. A subcutaneous dose should be considered in radiotherapy treatment planning involving the whole neck, especially in cases in which patients have undergone previous neck dissection

  19. Posttraumatic Orbital Emphysema: A Numerical Model

    Directory of Open Access Journals (Sweden)

    Andrzej Skorek

    2014-01-01

    Full Text Available Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features—thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall. The observation was made from 1·10-3 to 1·10-2 second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found.

  20. Emergence of Cranio-Cervico-Facial Soft Tissue Emphysema after Dental Hygiene Treatment Using Airflow (Case Report

    Directory of Open Access Journals (Sweden)

    Adamicova K.

    2015-09-01

    Full Text Available The authors report an interesting case of dangerous complications during dental hygienist treatment. Soft tissue emphysema during, and after stomatological procedures is described in several works. Such a complication after „airflowing“ has not yet been published in literature.

  1. Detection of Mild Emphysema by Computed Tomography Density Measurements

    International Nuclear Information System (INIS)

    Vikgren, J.; Friman, O.; Borga, M.; Boijsen, M.; Gustavsson, S.; Bake, B.; Tylen, U.; Ekberg-Jansson, A.

    2005-01-01

    Purpose: To assess the ability of a conventional density mask method to detect mild emphysema by high-resolution computed tomography (HRCT); to analyze factors influencing quantification of mild emphysema; and to validate a new algorithm for detection of mild emphysema. Material and Methods: Fifty-five healthy male smokers and 34 never-smokers, 61-62 years of age, were examined. Emphysema was evaluated visually, by the conventional density mask method, and by a new algorithm compensating for the effects of gravity and artifacts due to motion and the reconstruction algorithm. Effects of the reconstruction algorithm, slice thickness, and various threshold levels on the outcome of the density mask area were evaluated. Results: Forty-nine percent of the smokers had mild emphysema. The density mask area was higher the thinner the slice irrespective of the reconstruction algorithm and threshold level. The sharp algorithm resulted in increased density mask area. The new reconstruction algorithm could discriminate between smokers with and those without mild emphysema, whereas the density mask method could not. The diagnostic ability of the new algorithm was dependent on lung level. At about 90% specificity, sensitivity was 65-100% in the apical levels, but low in the rest of the lung. Conclusion: The conventional density mask method is inadequate for detecting mild emphysema, while the new algorithm improves the diagnostic ability but is nevertheless still imperfect

  2. Expression of matrix metalloproteinase-1 in alveolar macrophages, type II pneumocytes, and airways in smokers: relationship to lung function and emphysema.

    Science.gov (United States)

    Wallace, Alison M; Loy, Leanna B; Abboud, Raja T; D'Armiento, Jeanine M; Coxson, Harvey O; Muller, Nestor L; Kalloger, Steve; Li, Xing; Mark Elliott, W; English, John C; Finley, Richard J; Paré, Peter D

    2014-08-01

    An imbalance between proteolytic enzymes and their inhibitors is thought to be involved in the pathogenesis of chronic obstructive pulmonary disease. Matrix metalloproteinase-1, also known as interstitial collagenase, has been implicated as a potentially important proteinase in the genesis of chronic obstructive pulmonary disease and, more specifically, emphysema. We performed quantitative immunohistochemical assessment of matrix metalloproteinase-1 expression in the resected lung of 20 smokers/ex-smokers who had varying severity of airflow obstruction and emphysema and compared this with the lungs of 5 nonsmokers. Emphysema was measured using a morphometric measure of the lungs' surface area/volume ratio and with qualitative and quantitative computed tomography (CT) measures of emphysema. There were significantly more matrix metalloproteinase-1-expressing alveolar macrophages and type II pneumocytes as well as a greater percentage of small airways that stained positively for matrix metalloproteinase-1 in the lungs of smokers than in those of nonsmokers (p lung surface area/volume ratio and to qualitative estimates of emphysema on CT. These findings suggest that cigarette smoking increases expression of matrix metalloproteinase-1 in alveolar macrophages as well as in alveolar and small airway epithelial cells. Smokers who develop emphysema have increased alveolar macrophage expression of matrix metalloproteinase-1.

  3. Imaging findings of severe and critical severe pulmonary infections with A H1N1 influenza

    International Nuclear Information System (INIS)

    Chen Feng; Zhao Dawei; Wen Shuo; Li Hongjun; Wang Wei; He Ning; Zhang Ruichi; Song Wenyan

    2010-01-01

    Objective: To evaluate the pulmonary imaging features in patients with severe or critical severe A H1N1 influenza. Methods: Clinical and imaging findings of 18 cases with H1N1 pneumonia were retrospectively analyzed. These patients were divided into 2 groups including severe group (n=11) and critical group (n=7). Results: Among the severe group, bilateral ill-defined nodules and patch shadows were found in 8 cases, local ill-defined patchy was shown in 3 cases, and consolidation of right inferior lung was demonstrated by CT scan in 1 case. Among the critical group, diffuse ground-glass attenuation with partial consolidation were found in bilateral lungs of 4 cases, subcutaneous emphysema was observed in 1 case. CT showed diffuse ground-glass attenuation and nodular like consolidation in bilateral inferior lungs in 1 case, and other 3 cases showed diffuse consolidation of bilateral lungs. Conclusions: The radiologic findings of severe and critical severe pulmonary infections with H1N1 include ill-defined nodules and patch shadows of bilateral lung in sever patients, diffuse peribronchial ground-glass opacity and multifocal consolidation in critical severe patients. The radiologists should learn the features of H1N1 pneumonia on thoracic plain film and CTT to make diagnosis in time. (authors)

  4. Quantitative assessment of emphysema from whole lung CT scans: comparison with visual grading

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Apanosovich, Tatiyana V.; Wang, Jianwei; Yankelevitz, David F.; Henschke, Claudia I.

    2009-02-01

    Emphysema is a disease of the lungs that destroys the alveolar air sacs and induces long-term respiratory dysfunction. CT scans allow for imaging of the anatomical basis of emphysema and for visual assessment by radiologists of the extent present in the lungs. Several measures have been introduced for the quantification of the extent of disease directly from CT data in order to add to the qualitative assessments made by radiologists. In this paper we compare emphysema index, mean lung density, histogram percentiles, and the fractal dimension to visual grade in order to evaluate the predictability of radiologist visual scoring of emphysema from low-dose CT scans through quantitative scores, in order to determine which measures can be useful as surrogates for visual assessment. All measures were computed over nine divisions of the lung field (whole lung, individual lungs, and upper/middle/lower thirds of each lung) for each of 148 low-dose, whole lung scans. In addition, a visual grade of each section was also given by an expert radiologist. One-way ANOVA and multinomial logistic regression were used to determine the ability of the measures to predict visual grade from quantitative score. We found that all measures were able to distinguish between normal and severe grades (p<0.01), and between mild/moderate and all other grades (p<0.05). However, no measure was able to distinguish between mild and moderate cases. Approximately 65% prediction accuracy was achieved from using quantitative score to predict visual grade, with 73% if mild and moderate cases are considered as a single class.

  5. Pulmonary hyperinflation and emphysema in infants with the Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez, R.; Weisgrau, R.A.; Santamaria, M.

    1987-07-01

    Little recognition has been given to the pulmonary manifestations of the Marfan syndrome especially in infants. We report four cases of Marfan's syndrome presenting in infancy with respiratory abnormalities and a common radiographic picture of emphysema.

  6. Pulmonary hyperinflation and emphysema in infants with the Marfan syndrome

    International Nuclear Information System (INIS)

    Dominguez, R.; Weisgrau, R.A.; Santamaria, M.

    1987-01-01

    Little recognition has been given to the pulmonary manifestations of the Marfan syndrome especially in infants. We report four cases of Marfan's syndrome presenting in infancy with respiratory abnormalities and a common radiographic picture of emphysema. (orig./MG)

  7. Reducing surgery of volume for the pulmonary emphysema

    International Nuclear Information System (INIS)

    Ramirez, Juan Camilo

    1997-01-01

    The paper includes aspects as selection approaches, functional evaluation, imagenologic evaluation, cardiovascular evaluation, technical aspects and results among other topics related with the reducing surgery of volume of the pulmonary emphysema

  8. Combined pulmonary fibrosis and emphysema in hypersensitivity pneumonitis.

    Science.gov (United States)

    Soumagne, Thibaud; Pana-Katatali, Héloïse; Degano, Bruno; Dalphin, Jean-Charles

    2015-12-21

    Combined pulmonary fibrosis and emphysema is a distinct syndrome reported in patients who smoke. A 72-year-old, never-smoking female dairy farmer was referred for progressive dyspnoea on exertion, basal crackles on auscultation, normal spirometry and normal lung volumes but decreased diffusing capacity of the lung for carbon monoxide, centrilobular emphysema in the upper zones of the lungs and diffuse infiltrative lung disease in the lower zones on high-resolution CT scan. Bronchoalveolar lavage differential cell count showed 35% lymphocytosis, and precipitating antibodies for Wallemia sebi, Trichoderma species and Cladosporium sphaerospermum were identified. The diagnosis of farmer's lung disease with combined pulmonary fibrosis and emphysema was retained. This case highlights for the first time that hypersensitivity pneumonitis should be suspected in the setting of combined pulmonary fibrosis and emphysema in non-smoking patients. 2015 BMJ Publishing Group Ltd.

  9. Influence of experimental pulmonary emphysema on the toxicological effects from inhaled nitrogen dioxide and diesel exhaust

    International Nuclear Information System (INIS)

    Mauderly, J.L.; Bice, D.E.; Cheng, Y.S.; Gillett, N.A.; Henderson, R.F.; Pickrell, J.A.; Wolff, R.K.

    1989-01-01

    This project examined the influence of preexisting, experimentally induced pulmonary emphysema on the adverse health effects in rats of chronic inhalation exposure to either nitrogen dioxide or automotive diesel-engine exhaust. Previous reports indicated that humans with chronic lung disease were among those most severely affected by episodic exposures to high concentrations of airborne toxicants. There were no previous reports comparing the effects of chronic inhalation exposure to components of automotive emissions in emphysematous and normal animals. The hypothesis tested in this project was that rats with preexisting pulmonary emphysema were more susceptible than rats with normal lungs to the adverse effects of the toxicant exposures. Young adult rats were housed continuously in inhalation exposure chambers and exposed seven hours per day, five days per week, for 24 months to nitrogen dioxide at 9.5 parts per million (ppm)2, or to diesel exhaust at 3.5 mg soot/m3, or to clean air as control animals. These concentrations were selected to produce mild, but distinct, effects in rats with normal lungs. Pulmonary emphysema was induced in one-half of the rats by intratracheal instillation of the proteolytic enzyme elastase six weeks before the toxicant exposures began. Health effects were evaluated after 12, 18, and 24 months of exposure. The measurements included respiratory function, clearance of inhaled radiolabeled particles, pulmonary immune responses to instilled antigen, biochemistry and cytology of airway fluid, total lung collagen, histopathology, lung morphometry, and lung burdens of diesel soot. The significance of influences of emphysema and toxicant exposure, and interactions between influences of the two treatments, were evaluated by analysis of variance

  10. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema.

    Science.gov (United States)

    Sciurba, F C; Rogers, R M; Keenan, R J; Slivka, W A; Gorcsan, J; Ferson, P F; Holbert, J M; Brown, M L; Landreneau, R J

    1996-04-25

    Pulmonary function may improve after surgical resection of the most severely affected lung tissue (lung-reduction surgery) in patients with diffuse emphysema. The basic mechanisms responsible for the improvement, however, are not known. We studied 20 patients with diffuse emphysema before and at least three months after either a unilateral or a bilateral lung-reduction procedure. Clinical benefit was assessed by measurement of the six-minute walking distance and the transitional-dyspnea index, which is a subjective rating of the change from base line in functional impairment and the threshold for effort- and task- dependent dyspnea. Pressure-volume relations in the lungs were measured with static expiratory esophageal-balloon techniques, and right ventricular systolic function was assessed by echocardiography. The patients had significant improvement in the transitional-dyspnea index after surgery (Pelastic recoil of the lung, improved (from 1.3+/-0.6 cm of water per liter before surgery to 1.8+/-0.8 after, Pelastic recoil had a greater increase in the distance walked in six minutes than the other four patients, in whom recoil did not increase (P=0.02). The improved lung recoil led to disproportionate decreases in residual volume as compared with total lung capacity (16 percent vs. 6 percent), but the decreases in both values were significant (Pelastic recoil of the lung in patients with diffuse emphysema, leading to short-term improvement in dyspnea and exercise tolerance.

  11. Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract.

    Science.gov (United States)

    Papaioannou, Andriana I; Kostikas, Konstantinos; Manali, Effrosyni D; Papadaki, Georgia; Roussou, Aneza; Kolilekas, Likurgos; Borie, Raphaël; Bouros, Demosthenis; Papiris, Spyridon A

    2016-08-01

    Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. Patients with this condition experience severe dyspnea and impaired gas exchange with preserved lung volumes. The diagnosis of the CPFE syndrome is based on HRCT imaging, showing the coexistence of emphysema and pulmonary fibrosis both in varying extent and locations within the lung parenchyma. Individual genetic background seem to predispose to the development of the disease. The risk of the development of pulmonary hypertension in patients with CPFE is high and related to poor prognosis. CPFE patients also present a high risk of lung cancer. Mortality is significant in patients with CPFE and median survival is reported between 2.1 and 8.5 years. Currently, no specific recommendations are available regarding the management of patients with CPFE. In this review we provide information on the existing knowledge on CPFE regarding the pathophysiology, clinical manifestations, imaging, complications, possible therapeutic interventions and prognosis of the disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Paraseptal Emphysema: Prevalence and Distribution on CT and Association with Interstitial Lung Abnormalities

    Science.gov (United States)

    Araki, Tetsuro; Nishino, Mizuki; Zazueta, Oscar E.; Gao, Wei; Dupuis, Josée; Okajima, Yuka; Latourelle, Jeanne C.; Rosas, Ivan O.; Murakami, Takamichi; O’Connor, George T.; Washko, George R.; Hunninghake, Gary M.; Hatabu, Hiroto

    2015-01-01

    Objective To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and Methods We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, pemphysema and interstitial lung abnormalities (pemphysema was 3% in the FHS population, predominantly affects the upper lung zone, and contributes to decreased pulmonary function. Cigarette smoking, aging, and male gender were the factors associated with the presence of paraseptal emphysema. Significant association between paraseptal emphysema and interstitial lung abnormalities was observed. PMID:25868675

  13. High prevalence of emphysema and its association with BMI: a study of smokers with normal spirometry.

    Science.gov (United States)

    Stratelis, Georgios; Fransson, Sven-Göran; Schmekel, Birgitta; Jakobsson, Per; Mölstad, Sigvard

    2008-01-01

    To evaluate to what extent emphysema was evident, as identified by High Resolution Computed Tomography (HRCT), in smokers with normal lung function and to relate age, gender, smoking history, and body mass index (BMI) to the HRCT results. A secondary aim was to study to what extent emphysema was present in smokers with lower normal values of lung function defined as FEV(1)/FVC ratio percentage of predicted value (89-93% of predicted value for males and 90-93% for females) or FEF(50) smokers without this definition. Fifty-nine smokers, with a mean age of 53 years and with normal lung function, were examined with HRCT. Emphysema evidenced visually by HRCT was present in 43% of the subjects. Using a 0-5 grade scale (0=normal finding; 5=emphysema in most slices), the degree of emphysema was almost exclusively 3-4. The type of emphysema was distributed as centrilobular emphysema predominant in 43.5%, paraseptal emphysema predominant in 43.5%, and as an equal mixture of these types in 13%. The presence of emphysema did not differ between the group of smokers with lower normal values of lung function and the rest of the smokers. Smokers with emphysema had significantly lower BMI than those devoid of emphysema, 24 and 27 respectively (psmokers with normal lung function. The densitometric quantitative analysis method is inadequate for detecting mild emphysema. High prevalence of emphysema was associated with low BMI.

  14. Combined Pulmonary Fibrosis and Emphysema in Scleroderma-Related Lung Disease Has a Major Confounding Effect on Lung Physiology and Screening for Pulmonary Hypertension.

    Science.gov (United States)

    Antoniou, K M; Margaritopoulos, G A; Goh, N S; Karagiannis, K; Desai, S R; Nicholson, A G; Siafakas, N M; Coghlan, J G; Denton, C P; Hansell, D M; Wells, A U

    2016-04-01

    To assess the prevalence of combined pulmonary fibrosis and emphysema (CPFE) in systemic sclerosis (SSc) patients with interstitial lung disease (ILD) and the effect of CPFE on the pulmonary function tests used to evaluate the severity of SSc-related ILD and the likelihood of pulmonary hypertension (PH). High-resolution computed tomography (HRCT) scans were obtained in 333 patients with SSc-related ILD and were evaluated for the presence of emphysema and the extent of ILD. The effects of emphysema on the associations between pulmonary function variables and the extent of SSc-related ILD as visualized on HRCT and echocardiographic evidence of PH were quantified. Emphysema was present in 41 (12.3%) of the 333 patients with SSc-related ILD, in 26 (19.7%) of 132 smokers, and in 15 (7.5%) of 201 lifelong nonsmokers. When the extent of fibrosis was taken into account, emphysema was associated with significant additional differences from the expected values for diffusing capacity for carbon monoxide (DLco) (average reduction of 24.1%; P < 0.0005), and the forced vital capacity (FVC)/DLco ratio (average increase of 34.8%; P < 0.0005) but not FVC. These effects were identical in smokers and nonsmokers. Multivariate analysis showed that the presence of emphysema had a greater effect than echocardiographically determined PH on the FVC/DLco ratio, regardless of whether it was analyzed as a continuous variable or using a threshold value of 1.6 or 2.0. Among patients with SSc-related ILD, emphysema is sporadically present in nonsmokers and is associated with a low pack-year history in smokers. The confounding effect of CPFE on measures of gas exchange has major implications for the construction of screening algorithms for PH in patients with SSc-related ILD. © 2016, American College of Rheumatology.

  15. Computed tomography measurement of rib cage morphometry in emphysema.

    Directory of Open Access Journals (Sweden)

    Nicola Sverzellati

    Full Text Available BACKGROUND: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. METHODS: Rib cage diameters and areas (calculated from the inner surface of the rib cage in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT. CTs were analyzed with software, which allows quantification of total emphysema (emphysema%. The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. RESULTS: A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1%, and forced vital capacity (FVC% fit best with the rib cage measurements (R(2 = 64% for the rib cage area variation at the lower anatomical level. Gender had the biggest impact on rib cage diameter and area (105.3 cm(2; 95% CI: 111.7 to 98.8 for male lower area. Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm(2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%. Lower rib cage areas decreased as FVC% decreased (5.1 cm(2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation. CONCLUSIONS: This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema.

  16. 5-Aza-2'-deoxycytidine protects against emphysema in mice via suppressing p16Ink4a expression in lung tissue

    Directory of Open Access Journals (Sweden)

    He ZH

    2017-10-01

    Full Text Available Zhi-Hui He,1 Yan Chen,2 Ping Chen,2 Sheng-Dong He,2 Hui-Hui Zeng,2 Ji-Ru Ye,2 Da Liu,2 Jun Cao3 1Intensive Care Unit, 2Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, Changsha, 3Department of Respiratory Medicine, Hunan Provincial People’s Hospital, Changsha, China Background: There is a growing realization that COPD, or at least emphysema, involves several processes presenting in aging and cellular senescence. Endothelial progenitor cells (EPCs contribute to neovascularization and play an important role in the development of COPD. The gene for p16Ink4a is a major dominant senescence one. The aim of the present study was to observe changes in lung function, histomorphology of lung tissue, and expression of p16Ink4a in lung tissue and bone marrow-derived EPCs in emphysematous mice induced by cigarette-smoke extract (CSE, and further to search for a potential candidate agent protecting against emphysema induced by CSE. Materials and methods: An animal emphysema model was induced by intraperitoneal injection of CSE. 5-Aza-2'-deoxycytidine (5-Aza-CdR was administered to the emphysematous mice. Lung function and histomorphology of lung tissue were measured. The p16Ink4a protein and mRNA in EPCs and lung tissues were detected using Western blotting and quantitative reverse-transcription polymerase chain reaction, respectively. Results: CSE induced emphysema with increased p16Ink4a expression in lung tissue and bone marrow-derived EPCs. 5-Aza-CdR partly protected against emphysema, especially in the lung-morphology profile, and partly protest against the overexpression of p16Ink4a in EPCs and lung tissue induced by CSE. Conclusion: 5-Aza-CdR partly protected against emphysema in mice via suppressing p16Ink4a expression in EPCs and lung tissue. Keywords: 5-Aza-2'-deoxycytidine, cigarette smoke, emphysema, endothelial progenitor cells, p16Ink4a

  17. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Patel, Bipen D; Coxson, Harvey O; Pillai, Sreekumar G

    2008-01-01

    RATIONALE: It is unclear whether airway wall thickening and emphysema make independent contributions to airflow limitation in chronic obstructive pulmonary disease (COPD) and whether these phenotypes cluster within families. OBJECTIVES: To determine whether airway wall thickening and emphysema (1...

  18. [Combined pulmonary fibrosis and emphysema (CPFE)--limitation of usual lung function test and challenge at practice].

    Science.gov (United States)

    Takai, Daiya

    2014-12-01

    Spirometry and the flow-volume curve test are commonly performed lung function tests. However, a unique clinical entity occasionally shows almost normal data in these tests, and is therefore missed on screening tests. The clinical entity of combined pulmonary emphysema and pulmdoary fibrosis was recognized and documented in the 90's in Japan, the USA, and Europe. Typical emphysema shows obstructive disorders, and pulmonary fibrosis shows restrictive disorders. Thus, the combination of both should lead to a combined disorder pattern in lung function tests, but this is not the case. In 2005, Cottin reported and redefined this combination of emphysema and fibrosis of the lung as "Combined Pulmonary Fibrosis and Emphysema" (CPFE). The patients are typically heavily smoking males who show an almost normal lung function. The upper lobe of these patients usually shows severe emphysema, which contributes to a static volume and a late phase in the forced volume test. On the other hand their lower lobe shows fibrotic change. The fibrotic portion contributes to early phase flow in the flow-volume curve. These mechanisms are a reason for the normal pattern appearance in lung function tests in CPFE patients. As a matter of course, these patients have damaged upper and lower lobes: their diffusing capacity of the lung shows a low performance, their saturation of blood hemoglobin decreases soon after light exercise, and their KL-6 (a blood marker of pulmonary fibrosis) usually shows a high value. They are considered a high risk group regarding complications of post-surgical treatment. Thus, when medical technologists identify suspicious cases, they should advise doctors to add diffusing capacity and KL-6 tests. (Review).

  19. Hhip haploinsufficiency sensitizes mice to age-related emphysema.

    Science.gov (United States)

    Lao, Taotao; Jiang, Zhiqiang; Yun, Jeong; Qiu, Weiliang; Guo, Feng; Huang, Chunfang; Mancini, John Dominic; Gupta, Kushagra; Laucho-Contreras, Maria E; Naing, Zun Zar Chi; Zhang, Li; Perrella, Mark A; Owen, Caroline A; Silverman, Edwin K; Zhou, Xiaobo

    2016-08-09

    Genetic variants in Hedgehog interacting protein (HHIP) have consistently been associated with the susceptibility to develop chronic obstructive pulmonary disease and pulmonary function levels, including the forced expiratory volume in 1 s (FEV1), in general population samples by genome-wide association studies. However, in vivo evidence connecting Hhip to age-related FEV1 decline and emphysema development is lacking. Herein, using Hhip heterozygous mice (Hhip(+/-)), we observed increased lung compliance and spontaneous emphysema in Hhip(+/-) mice starting at 10 mo of age. This increase was preceded by increases in oxidative stress levels in the lungs of Hhip(+/-) vs. Hhip(+/+) mice. To our knowledge, these results provide the first line of evidence that HHIP is involved in maintaining normal lung function and alveolar structures. Interestingly, antioxidant N-acetyl cysteine treatment in mice starting at age of 5 mo improved lung function and prevented emphysema development in Hhip(+/-) mice, suggesting that N-acetyl cysteine treatment limits the progression of age-related emphysema in Hhip(+/-) mice. Therefore, reduced lung function and age-related spontaneous emphysema development in Hhip(+/-) mice may be caused by increased oxidative stress levels in murine lungs as a result of haploinsufficiency of Hhip.

  20. Lung cancer, pulmonary emphysema and pleural effusion: An autopsy study.

    Science.gov (United States)

    Marel, Miloslav; Koubkova, Leona; Kovarikova, Zuzana; Grandcourtova, Alzbeta; Petrik, Frantisek; Hroudova, Hana; Capkova, Linda; Kodet, Roman; Fila, Libor

    2015-12-01

    To determine the exact incidence of lung cancer, pulmonary emphysema and pleural effusion we decided to carry out an autopsy study. In this autopsy study carried out over two years, we compared the results of autopsy findings with the clinical data in accompanying records of the deceased. Among the 708 deceased subjects, there were 398 males and 310 females with a median age of 71 years. At autopsy, 55 cases of lung carcinoma (BCA) were found, of which 24 have not been identified during life (44%). Among the deceased with BCA, emphysema was also observed at autopsy in 40% of the cases. Pulmonary emphysema was described macroscopically in 28% of the full set of 708 deceased, whereas the accompanying records of the deceased described this condition in only 12% of the cases. Microscopic changes compatible with emphysema were identified in 54% of the examined lungs. Pleural effusions were described in the accompanying records of 13% of the deceased, while the autopsies showed this condition in 33% of the deceased. BCA was accompanied by effusion in 25% of the cases. The obtained results show that the studied conditions are present in more cases than are reported by clinicians. The study confirms the commonly accepted association between lung cancer and emphysema.

  1. Soluble receptor for advanced glycation end products in COPD: relationship with emphysema and chronic cor pulmonale: a case-control study.

    Science.gov (United States)

    Miniati, Massimo; Monti, Simonetta; Basta, Giuseppina; Cocci, Franca; Fornai, Edo; Bottai, Matteo

    2011-03-30

    The receptor for advanced glycation end products (RAGE) is a multiligand signal transduction receptor that can initiate and perpetuate inflammation. Its soluble isoform (sRAGE) acts as a decoy receptor for RAGE ligands, and is thought to afford protection against inflammation. With the present study, we aimed at determining whether circulating sRAGE is correlated with emphysema and chronic cor pulmonale in chronic obstructive pulmonary disease (COPD). In 200 COPD patients and 201 age- and sex-matched controls, we measured lung function by spirometry, and sRAGE by ELISA method. We also measured the plasma levels of two RAGE ligands, N-epsilon-carboxymethyl lysine and S100A12, by ELISA method. In the COPD patients, we assessed the prevalence and severity of emphysema by computed tomography (CT), and the prevalence of chronic cor pulmonale by echocardiography. Multiple quantile regression was used to assess the effects of emphysema, chronic cor pulmonale, smoking history, and comorbid conditions on the three quartiles of sRAGE. sRAGE was significantly lower (p = 0.007) in COPD patients (median 652 pg/mL, interquartile range 484 to 1076 pg/mL) than in controls (median 869 pg/mL, interquartile range 601 to 1240 pg/mL), and was correlated with the severity of emphysema (p cor pulmonale than in those without (p = 0.002). Such difference remained statistically significant after adjusting for smoking history, comorbidities, and emphysema severity. There was no significant difference in the plasma levels of the two RAGE ligands between cases and controls. sRAGE is significantly lower in patients with COPD than in age- and sex-matched individuals without airflow obstruction. Emphysema and chronic cor pulmonale are independent predictors of reduced sRAGE in COPD.

  2. Value of cardiac catheterization and cineangiography in infantile lobar emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Roguin, N.; Peleg, H.; Naveh, Y.; Riss, E.

    1980-01-01

    Lobar emphysema is an uncommon cause of respiratory distress in infancy. Congenital heart disease is seen in about 20% of the patients with infantile (congenital) lobar emphysema. We described six infants with lobar emphysema. In three of them a congenital heart disease was demonstrated by cardiac catheterization and cineangiography; two had a tetralogy of Fallot with right aortic arch and the third infant a ventricular septal defect. The pulmonary angiography showed stretching of the arteries with very poor filling of the peripheral arteries and a characteristic smaller pulmonary vein in the affected lobe. In all the six patients the pulmonary artery pressure was normal. All the patients underwent lobectomy with good results. We feel that a preoperative cardiac catheterization and cineangiography is of value in this very sick group of infants.

  3. Assessment of regional progression of pulmonary emphysema with CT densitometry

    DEFF Research Database (Denmark)

    Bakker, M Els; Putter, Hein; Stolk, Jan

    2008-01-01

    Z patients showed more basal emphysema than the non-PiZ group (craniocaudal locality, - 40.0 g/L vs - 6.2 g/L). Overall progression rate in PiZ patients was lower than in non-PiZ subjects. A significant correlation was found between craniocaudal locality and progression slope in PiZ subjects (R = 0.566, p...... with general emphysema (general emphysema without phenotype PiZZ [non-PiZ] group) were scanned with CT at baseline and after 30 months. Densitometry was performed in 12 axial partitions of equal volumes. To indicate predominant location, craniocaudal locality was defined as the slope in the plot of densities...

  4. Pathogenesis of pulmonary emphysema – cellular and molecular events

    Directory of Open Access Journals (Sweden)

    Antonio Di Petta

    2010-06-01

    Full Text Available Pulmonary emphysema is a chronic obstructive disease, resulting fromimportant alterations in the whole distal structure of terminal bronchioles, either by enlargement of air spaces or by destruction of the alveolar wall, leading to loss of respiratory surface, decreased elastic recoil and lung hyperinflation. For many years, the hypothesis of protease-antiprotease unbalance prevailed as the central theme in the pathogenesis of pulmonary emphysema. According to this hypothesis, the release of active proteolytic enzymes, produced mainly by neutrophils and macrophages, degrades the extracellular matrix, affecting the integrity of its components, especially collagen and elastic fibers. However, new concepts involving cellular and molecular events were proposed, including oxidative stress, cell apoptosis, cellular senescence and failed lung tissue repair. The aim of this review paper was to evaluate the cellular and molecular mechanisms seen in the pathogenesis of pulmonary emphysema.

  5. Patient selection for subcutaneous versus sublingual immunotherapy.

    Science.gov (United States)

    Larenas-Linnemann, Désirée

    2015-12-01

    With the Food and Drug Administration's approval of sublingual allergen-specific immunotherapy (SL-AIT) tablets for grass and ragweed pollen, SL-AIT is progressively gathering importance not only in Europe, but also in the United States and other parts of the world. We reviewed issues related to the selection of patients for the sublingual or the subcutaneous route for allergic patients, based on what has been published since January 2014 on subcutaneous-versus-SL-AIT efficacy, safety and other issues. (Figure is included in full-text article.) As patient's adherence seems one of the major problems in real-life AIT, investigators have sought how to enhance AIT simplicity by changing the route to home-administrated SL-AIT, and by shortening the subcutaneous-allergen-specific immunotherapy (SC-AIT) build-up or maintenance phase. The latter was safe with several hypoallergenic extracts. As for SL-AIT, double blind placebo-controlled large trials in patients with allergic rhinitis and asthma have shown the efficacy and safety of ragweed pollen and house dust mite SLIT tablets and highly concentrated liquid formulations, primarily in adults. A large trial with SLIT in 3-year-old children was effective. With the improvement of SL-AIT efficacy, the selection of SC-versus-SL-AIT will probably increasingly be based not on efficacy, but on practical aspects, without losing sight of which SL-AIT products have proven efficacy.

  6. “Cor pulmonale parvus” in chronic obstructive pulmonary disease (COPD) and emphysema. The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study

    Science.gov (United States)

    Kawut, Steven M.; Poor, Hooman D.; Parikh, Megha A.; Hueper, Katja; Smith, Benjamin M.; Bluemke, David A.; Lima, Joao A.; Prince, Martin R.; Hoffman, Eric A.; Austin, John H. M.; Vogel-Claussen, Jens; Barr, R. Graham

    2015-01-01

    Background The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale, or enlargement of the right ventricle (RV). Most studies of cor pulmonale were conducted decades ago. Objective We aimed to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance imaging (MRI). Methods We performed a case-control study nested predominantly in two general population studies of 310 participants with COPD and controls ages 50–79 years with ≥ 10 pack-years of smoking and who were free of clinical cardiovascular disease. RV volumes and mass were assessed using MRI. COPD and COPD severity were defined by standard spirometric criteria. Percent emphysema was defined as percent of lung regions cor pulmonale parvus”) and this reduction is related to greater percent emphysema on computed tomography. PMID:25440095

  7. Pulmonary interstitial emphysema in neonates -reporting of 11 cases

    International Nuclear Information System (INIS)

    Alvares, Beatriz Regina; Santos Mezzacappa, Maria Aparecida dos; Marba, Sergio Tadeu Martins

    1997-01-01

    The present paper relates the radiologic and clinical aspects of pulmonary interstitial emphysema in 11 infants submitted to assisted ventilation. The radiologic diagnosis was made using the classification of Boothroyd and Barson (levels I to III). A prevalence of pulmonary interstitial emphysema of levels II and III was observed in masculine premature infants with hyaline membrane disease and intrauterine pneumonia. Mortality was high and occurred in the infants with advanced levels of the disease. The authors emphasize the importance of early radiologic diagnosis of this condition during the treatment of premature infants submitted to assisted ventilation. (author)

  8. [Cellular subcutaneous tissue. Anatomic observations].

    Science.gov (United States)

    Marquart-Elbaz, C; Varnaison, E; Sick, H; Grosshans, E; Cribier, B

    2001-11-01

    We showed in a companion paper that the definition of the French "subcutaneous cellular tissue" considerably varied from the 18th to the end of the 20th centuries and has not yet reached a consensus. To address the anatomic reality of this "subcutaneous cellular tissue", we investigated the anatomic structures underlying the fat tissue in normal human skin. Sixty specimens were excised from the surface to the deep structures (bone, muscle, cartilage) on different body sites of 3 cadavers from the Institut d'Anatomie Normale de Strasbourg. Samples were paraffin-embedded, stained and analysed with a binocular microscope taking x 1 photographs. Specimens were also excised and fixed after subcutaneous injection of Indian ink, after mechanic tissue splitting and after performing artificial skin folds. The aspects of the deep parts of the skin greatly varied according to their anatomic localisation. Below the adipose tissue, we often found a lamellar fibrous layer which extended from the interlobular septa and contained horizontally distributed fat cells. No specific tissue below the hypodermis was observed. Artificial skin folds concerned either exclusively the dermis, when they were superficial or included the hypodermis, but no specific structure was apparent in the center of the fold. India ink diffused to the adipose tissue, mainly along the septa, but did not localise in a specific subcutaneous compartment. This study shows that the histologic aspects of the deep part of the skin depend mainly on the anatomic localisation. Skin is composed of epidermis, dermis and hypodermis and thus the hypodermis can not be considered as being "subcutaneous". A difficult to individualise, fibrous lamellar structure in continuity with the interlobular septa is often found under the fat lobules. This structure is a cleavage line, as is always the case with loose connective tissues, but belongs to the hypodermis (i.e. fat tissue). No specific tissue nor any virtual space was

  9. stausartikel: behandling af subcutane abscesser

    DEFF Research Database (Denmark)

    Hardgrib, Nina; Petersen, Klaus Kjær

    2017-01-01

    be administered, and the cavity should be closed without dead space. Antibiotics should not routinely be given, but always be considered in immunocompromised patients or patients with septicaemia. Routine examination of the microbiology has no influence on the treatment and is not recommended.......Simple subcutaneous abscesses are common, and we have examined the literature concerning the ideal treatment of subcutaneous abscesses. We recommend radical debridement with removal of all pus, the abscess wall and any necrosis. If primary suture is chosen, preoperative antibiotics should...

  10. Different histological subtypes of peripheral lung cancer based on emphysema distribution in patients with both airflow limitation and CT-determined emphysema.

    Science.gov (United States)

    Shin, Beomsu; Shin, Sumin; Chung, Myung Jin; Lee, Hyun; Koh, Won-Jung; Kim, Hojoong; Park, Hye Yun

    2017-02-01

    The histological subtypes by peripheral tumor location remain uncharacterized in COPD patients with emphysema. We investigated histologic subtypes of peripheral lung cancers based on the context of heterogeneous emphysema distribution in patients with airflow limitation and CT-determined emphysema. A retrospective, cross-sectional study was conducted using data from 754 patients with airflow limitation and newly-diagnosed primary lung cancers from February 2013 to February 2015. Of these, 230 patients had emphysema, as determined by computed tomography software designed to quantify emphysema. Among the 230 patients, the most common subtype in central lesions (n=84) was squamous cell carcinoma (SCC) (n=64/84, 76%). Adenocarcinoma (ADC) was more frequently observed in peripheral lesions (n=146) than central lesions (58/146 [40%] vs. 4/84 [5%], pemphysema than emphysema areas (43/74 [58%] vs. 15/72 [21%], pemphysema areas than areas without emphysema (44/72 [61%] vs. 13/74 [18%], pemphysema, the main histological subtype of peripheral lung cancer was SCC in emphysema areas and ADC in areas without emphysema. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. 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

  12. Modeling the influence of vitamin D deficiency on cigarette smoke-induced emphysema.

    Directory of Open Access Journals (Sweden)

    Mardi A. Crane-Godreau

    2013-06-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a major cause of morbidity and mortality worldwide. While the primary risk factor for COPD is cigarette smoke exposure, vitamin D deficiency has been epidemiologically implicated as a factor in the progressive development of COPD-associated emphysema. Because of difficulties inherent to studies involving multiple risk factors in the progression of COPD in humans, we developed a murine model in which to study the separate and combined effects of vitamin D deficiency and cigarette smoke exposure. During a 16 week period, mice were exposed to one of four conditions, control diet breathing room air (CD-NS, control diet with cigarette smoke exposure (CD-CSE, vitamin D deficient diet breathing room air (VDD-NS or vitamin D deficient diet with cigarette smoke exposure (VDD-CSE. At the end of the exposure period, the lungs were examined by a pathologist and separately by morphometric analysis. In parallel experiments, mice were anesthetized for pulmonary function testing followed by sacrifice and analysis. Emphysema (determined by an increase in alveolar mean linear intercept length was more severe in the VDD-CSE mice compared to control animals and animals exposed to VDD or CSE alone. The VDD-CSE and the CD-CSE mice had increased total lung capacity and increased static lung compliance. There was also a significant increase in the matrix metalloproteinase-9: tissue inhibitor of metalloproteinases-1 ratio in VDD-CSE mice compared with all controls. Alpha-1 antitrypsin expression was reduced in VDD-CSE mice as well. In summary, vitamin D deficiency, when combined with cigarette smoke exposure, seemed to accelerate the appearance of emphysemas, perhaps by virtue of an increased protease-antiprotease ratio in the combined VDD-CSE animals. These results support the value of our mouse model in the study of COPD.

  13. Aspiration, atelektasis, emphysema with special regard to children and adolescents

    International Nuclear Information System (INIS)

    Reither, M.; Giessen Univ.

    1982-01-01

    The most important factors of acute respiratory diseases in childhood are reported. Above all the characteristic features of airway obstructions in chest films are presented: In newborn suffering from aspiration we find diffuse patchy and illdefined densities combined with atelectasis. In patients with aspiration of foreign bodies a unilaterally localized complete or partial emphysema of the lung in in- and particulary in exspiration followed by mediastinal shifting is pathognomonic. Chest films in in- and exspiration are therefore mandatory. Atelectases are not uncommon in ventilated and operated patients. Emphysemata arise also in such patients; a particular emphysema is the so-called congenital lobar emphysema due to an upper lobe obstruction in most patients. Finally children suffering from spastic bronchitis and asthma present pulmonary emphysema. Generally chest films in different projections and not only in inspiration but also in exspiration allow to establish the correct diagnosis of the most important airway obstructions in children and to give rapid and sure informations for treatment. (orig.) [de

  14. Immunomodulatory strategies prevent the development of autoimmune emphysema

    Directory of Open Access Journals (Sweden)

    Kraskauskiene Vita

    2010-12-01

    Full Text Available Abstract Background The presence of anti-endothelial cell antibodies and pathogenic T cells may reflect an autoimmune component in the pathogenesis of emphysema. Whether immune modulatory strategies can protect against the development of emphysema is not known. Methods Sprague Dawley rats were immunized with human umbilical vein endothelial cells (HUVEC to induce autoimmune emphysema and treated with intrathymic HUVEC-injection and pristane. Measurements of alveolar airspace enlargement, cytokine levels, immuno histochemical, western blot analysis, and T cell repertoire of the lung tissue were performed. Results The immunomodulatory strategies protected lungs against cell death as demonstrated by reduced numbers of TUNEL and active caspase-3 positive cells and reduced levels of active caspase-3, when compared with lungs from HUVEC-immunized rats. Immunomodulatory strategies also suppressed anti-endothelial antibody production and preserved CNTF, IL-1alpha and VEGF levels. The immune deviation effects of the intrathymic HUVEC-injection were associated with an expansion of CD4+CD25+Foxp3+ regulatory T cells. Pristane treatment decreased the proportion of T cells expressing receptor beta-chain, Vβ16.1 in the lung tissue. Conclusions Our data demonstrate that interventions classically employed to induce central T cell tolerance (thymic inoculation of antigen or to activate innate immune responses (pristane treatment can prevent the development of autoimmune emphysema.

  15. Pulmonary emphysema and tumor microenvironment in primary lung cancer.

    Science.gov (United States)

    Murakami, Junichi; Ueda, Kazuhiro; Sano, Fumiho; Hayashi, Masataro; Nishimoto, Arata; Hamano, Kimikazu

    2016-02-01

    To clarify the relationship between the presence of pulmonary emphysema and tumor microenvironment and their significance for the clinicopathologic aggressiveness of non-small cell lung cancer. The subjects included 48 patients with completely resected and pathologically confirmed stage I non-small cell lung cancer. Quantitative computed tomography was used to diagnose pulmonary emphysema, and immunohistochemical staining was performed to evaluate the matrix metalloproteinase (MMP) expression status in the intratumoral stromal cells as well as the microvessel density (MVD). Positive MMP-9 staining in the intratumoral stromal cells was confirmed in 17 (35%) of the 48 tumors. These 17 tumors were associated with a high MVD, frequent lymphovascular invasion, a high proliferative activity, and high postoperative recurrence rate (all, P pulmonary emphysema (P = 0.02). Lung cancers arising from pulmonary emphysema were also associated with a high MVD, proliferative activity, and postoperative recurrence rate (all, P < 0.05). The MMP-9 expression in intratumoral stromal cells is associated with the clinicopathologic aggressiveness of lung cancer and is predominantly identified in tumors arising in emphysematous lungs. Further studies regarding the biological links between the intratumoral and extratumoral microenvironment will help to explain why lung cancers originating in emphysematous lung tissues are associated with a poor prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Emphysema and chronic obstructive pulmonary disease in coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Tomas, L.H.S. [Medical College of Wisconsin, Milwaukee, WI (United States)

    2011-03-15

    Coal mining remains a major industry that has workers at risk for developing chronic lung disease. Aside from simple coal workers' pneumoconiosis and progressive massive fibrosis, the development of emphysema and obstructive lung disease independent of smoking may be underappreciated. This article reviews more recent studies that may help rectify this faulty view. Cumulative exposure to coal dust is a significant risk factor for the development of emphysema and has an additive effect to smoking. Increased coal dust exposure is associated with increased risk of death from chronic obstructive pulmonary disease (COPD). In newly employed coal miners, bronchitic symptoms are associated with a rapid decline in lung function within 2 years after starting work. In evaluating impairment, the chest radiograph may be helpful as a marker of exposure but the diffusing capacity is most correlated with dyspnea, whereas the emphysema computed tomography score has good association with expiratory flow limitation. Latest studies further support the association of emphysema and COPD with coal dust exposure. Increased cumulative exposure may also increase risk of death from these diseases.

  17. Predisposing factors of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy: comparison between CT emphysema score and pulmonary function test

    International Nuclear Information System (INIS)

    Lee, Chang Ho; Park, Kyung Joo; Park, Dong Won; Jung, Kyung Il; Suh, Jung Ho

    1997-01-01

    To compare the CT emphysema score with various factors of pulmonary function test by simple spirometry and to use the result as a predictor of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy. The CT scans of 106 patients who had undergone percutaneous transthoracic fine needle aspiration biopsy of lung lesions within the previous 18 months were retrospectively reviewed. In 75 of these 106 cases, the results of the pulmonary function test were also reviewed. On plain chest radiography, pneumothorax was noted in 20 cases (19%). Emphysema was blindly evaluated. We divided each lung into four segments and determined the severity and involved volume of emphysema, as seen on CT. Severity was classified as one of four grades, as follow : absence of emphysema=0 ; low attenuation area of less than 5mm=1 ; low attenuation area of more than 5mm, and vascular pruning with normal lung intervening=2 ; and diffuse low attenuation without intervening normal lung, and larger confluent low attenuation with vascular pruning and distortion of branching pattern occupying all or almost all the involved parenchyma=3. The involved area was also classified as one of four grades : less than 25%=1 ; 25 - 49%=2 ; 51 - 74%=3 ; and more than 75%=4. The CT emphysema score was defined as the average of the grade of severity multiplied by the grade of involved area. Pulmonary function tests, consisting of simple spirometry and a pulmonologist's interpretation, were evaluated. We also evaluated depth and size of lesion as known predisposing factors in postbioptic pneumothorax. Statistical analysis was performed using the chi-square test, Wilcoxon ranks sum W test and the student t test. A comparison between the two groups of occurrence(with or without pneumothorax) showed the emphysema scores to be 1.69±2.0 and 1.11±2.9, respectively ; there was thus no significant difference between the two groups (z= - 0.048, p>0.10). Nor were differences revealed by the pulmonary

  18. Predisposing factors of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy: comparison between CT emphysema score and pulmonary function test

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Ho; Park, Kyung Joo; Park, Dong Won; Jung, Kyung Il; Suh, Jung Ho [Ajou Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-11-01

    To compare the CT emphysema score with various factors of pulmonary function test by simple spirometry and to use the result as a predictor of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy. The CT scans of 106 patients who had undergone percutaneous transthoracic fine needle aspiration biopsy of lung lesions within the previous 18 months were retrospectively reviewed. In 75 of these 106 cases, the results of the pulmonary function test were also reviewed. On plain chest radiography, pneumothorax was noted in 20 cases (19%). Emphysema was blindly evaluated. We divided each lung into four segments and determined the severity and involved volume of emphysema, as seen on CT. Severity was classified as one of four grades, as follow : absence of emphysema=0 ; low attenuation area of less than 5mm=1 ; low attenuation area of more than 5mm, and vascular pruning with normal lung intervening=2 ; and diffuse low attenuation without intervening normal lung, and larger confluent low attenuation with vascular pruning and distortion of branching pattern occupying all or almost all the involved parenchyma=3. The involved area was also classified as one of four grades : less than 25%=1 ; 25 - 49%=2 ; 51 - 74%=3 ; and more than 75%=4. The CT emphysema score was defined as the average of the grade of severity multiplied by the grade of involved area. Pulmonary function tests, consisting of simple spirometry and a pulmonologist's interpretation, were evaluated. We also evaluated depth and size of lesion as known predisposing factors in postbioptic pneumothorax. Statistical analysis was performed using the chi-square test, Wilcoxon ranks sum W test and the student t test. A comparison between the two groups of occurrence(with or without pneumothorax) showed the emphysema scores to be 1.69{+-}2.0 and 1.11{+-}2.9, respectively ; there was thus no significant difference between the two groups (z= - 0.048, p>0.10). Nor were differences revealed by the

  19. Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Araki, Tetsuro, E-mail: taraki@partners.org [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama (Japan); Nishino, Mizuki [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Zazueta, Oscar E. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Gao, Wei [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); Dupuis, Josée [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); The National Heart Lung and Blood Institute' s Framingham Heart Study, Framingham, MA (United States); Okajima, Yuka [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Latourelle, Jeanne C. [Department of Medicine and Neurology, Boston University School of Medicine, Boston, MA (United States); Rosas, Ivan O. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Murakami, Takamichi [Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama (Japan); O’Connor, George T. [The National Heart Lung and Blood Institute' s Framingham Heart Study, Framingham, MA (United States); Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA (United States); Washko, George R.; Hunninghake, Gary M. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); and others

    2015-07-15

    Highlights: • The prevalence of pure paraseptal emphysema was 3% (85/2633) in the Framingham Heart Study population, predominantly affects the upper lung zone, and contributes to slightly decreased pulmonary function. • There was significant association between paraseptal emphysema and interstitial lung abnormalities, which is a novel finding. • Prevalence of paraseptal emphysema and its impact on pulmonary function could have been underestimated in the previous reports. - Abstract: Objective: To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and methods: We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of the participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results: Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, P < 0.001) and had significantly decreased FEV{sub 1}/FVC% (P = 0.002), and diffusion capacity of carbon monoxide (DLCO) (P = 0.002). There was a significant association between pure paraseptal emphysema and interstitial lung abnormalities (P < 0.001). Conclusions: The prevalence of pure paraseptal emphysema was 3% in the

  20. Subcutaneous sarcoidosis associated with sarcoid tenosynovitis.

    Science.gov (United States)

    Enzenauer, R J; Waterhouse, W J; West, S G

    1996-10-01

    Subcutaneous sarcoidosis and sarcoid tenosynovitis are unusual manifestations of systemic sarcoidosis. We report two Japanese women with disseminated sarcoidosis presenting with subcutaneous and tenosynovial involvement demonstrated by computed tomography and magnetic resonance imaging. Sarcoidosis must be considered in the differential diagnosis of unexplained subcutaneous nodulosis or tenosynovitis in patients with or without a previous diagnosis of sarcoidosis.

  1. Subcutaneous hemangiomas of the hand.

    Science.gov (United States)

    Palmieri, T J

    1983-03-01

    Subcutaneous hemangiomas, the fourth most common tumor of the hand, consist primarily of proliferating blood vessels within the soft tissue. One hundred and sixty consecutive patients with the histologic diagnosis of subcutaneous hemangiomas were reviewed. Patients with diffuse hemangiomas, strawberry nevi, and arteriovenous fistulae were not included in the study. The median age was 32 years, the youngest being 2 years old and the oldest 68. Sixty-two percent of the patients were female. None had a history of trauma. The palm was the most common location. Progressive enlargement of the lesion and throbbing pain were the most common symptoms. As is characteristic of hemangiomas, they were readily compressible, poorly defined, bluish, subcutaneous masses that distended when the venous return was obstructed and contracted when the extremity was elevated. Roentgenographic evaluation rarely showed the typical calcification of phleboliths, but a soft tissue mass was almost always present. All of these hemangiomas were surgically excised, with the tributory vessels being identified and ligated as far distant from the tumor as possible in order to diminish the chances of recurrence.

  2. GENERATIVE METHOD TO DISCOVER EMPHYSEMA SUBTYPES WITH UNSUPERVISED LEARNING USING LUNG MACROSCOPIC PATTERNS (LMPS): THE MESA COPD STUDY.

    Science.gov (United States)

    Song, Jingkuan; Yang, Jie; Smith, Benjamin; Balte, Pallavi; Hoffman, Eric A; Barr, R Graham; Laine, Andrew F; Angelini, Elsa D

    2017-04-01

    Pulmonary emphysema overlaps considerably with chronic obstructive pulmonary disease (COPD), and is traditionally subcategorized into three subtypes: centrilobular emphysema (CLE), panlobular emphysema (PLE) and paraseptal emphysema (PSE). Automated classification methods based on supervised learning are generally based upon the current definition of emphysema subtypes, while unsupervised learning of texture patterns enables the objective discovery of possible new radiological emphysema subtypes. In this work, we use a variant of the Latent Dirichlet Allocation (LDA) model to discover lung macroscopic patterns (LMPs) in an unsupervised way from lung regions that encode emphysematous areas. We evaluate the possible utility of the LMPs as potential novel emphysema subtypes via measuring their level of reproducibility when varying the learning set and by their ability to predict traditional radiological emphysema subtypes. Experimental results show that our algorithm can discover highly reproducible LMPs, that predict traditional emphysema subtypes.

  3. Detection and classification of interstitial lung diseases and emphysema using a joint morphological-fuzzy approach

    Science.gov (United States)

    Chang Chien, Kuang-Che; Fetita, Catalin; Brillet, Pierre-Yves; Prêteux, Françoise; Chang, Ruey-Feng

    2009-02-01

    Multi-detector computed tomography (MDCT) has high accuracy and specificity on volumetrically capturing serial images of the lung. It increases the capability of computerized classification for lung tissue in medical research. This paper proposes a three-dimensional (3D) automated approach based on mathematical morphology and fuzzy logic for quantifying and classifying interstitial lung diseases (ILDs) and emphysema. The proposed methodology is composed of several stages: (1) an image multi-resolution decomposition scheme based on a 3D morphological filter is used to detect and analyze the different density patterns of the lung texture. Then, (2) for each pattern in the multi-resolution decomposition, six features are computed, for which fuzzy membership functions define a probability of association with a pathology class. Finally, (3) for each pathology class, the probabilities are combined up according to the weight assigned to each membership function and two threshold values are used to decide the final class of the pattern. The proposed approach was tested on 10 MDCT cases and the classification accuracy was: emphysema: 95%, fibrosis/honeycombing: 84% and ground glass: 97%.

  4. [VENT: International study of bronchoscopic lung volume reduction as a palliative treatment for emphysema].

    Science.gov (United States)

    Leroy, S; Marquette, C H

    2004-12-01

    Therapeutic options for patients with severe emphysema remain limited. In selected patients, lung volume reduction surgery has been shown to improve pulmonary function, exercise capacity, quality of life and also survival. The technique of inserting one-way valves endoscopically into the airways supplying the most affected areas of lung provides the possibility of achieving similar results to surgery (i.e. volume reduction) in a less invasive way, which is also reversible, since the valves can be removed at any time. This technique has been shown to be safe. The aim of this study is to evaluate the efficacy of this technique compared to optimal medical therapy in patients with heterogeneous emphysema defined according to radiological criteria. A prospective, international, multicentre (20 centres) randomised trial is underway to establish the efficacy and safety of endobronchial valve placement in this patient group. This study will enrol 270 patients and be analysed on an intention to treat basis. Patients are randomised either to valve insertion or optimal medical treatment alone in a ratio of 2 to 1. Follow up will be ensured for at least one year. The two principal outcome measures will be improvement at six months in FEV1 and in six minute walk distance. The safety of the technique will be evaluated over the same period. Details of the study are available online for patients and their physicians at www.euroemphysema.com.

  5. Subcutaneous blood flow in psoriasis

    International Nuclear Information System (INIS)

    Klemp, P.

    1985-01-01

    The simultaneously recorded disappearance rates of 133 xe from subcutaneous adipose tissue in the crus were studied in 10 patients with psoriasis vulgaris using atraumatic labeling of the tissue in lesional skin (LS) areas and symmetrical, nonlesional skin (NLS) areas. Control experiments were performed bilaterally in 10 younger, healthy subjects. The subcutaneous washout rate constant was significantly higher in LS, 0.79 +/- 0.05 min-1 x 10(2) compared to the washout rate constant of NLS, 0.56 +/- 0.07 min-1. 10(2), or the washout rate constant in the normal subjects, 0.46 +/- 0.17 min-1 x 10(2). The mean washout rate constant in NLS was 25% higher than the mean washout rate constant in the normal subjects. The difference was, however, not statistically significant. Differences in the washout rate constants might be due to abnormal subcutaneous tissue-to-blood partition (lambda) in the LS--and therefore not reflecting the real differences in the subcutaneous blood flow (SBF). The lambda for 133 Xe was therefore measured--using a double isotope washout method ( 133 Xe and [ 131 I]antipyrine)--in symmetrical sites of the lateral crus in LS and NLS of 10 patients with psoriasis vulgaris and in 10 legs of normal subjects. In LS the lambda was 4.52 +/- 1.67 ml/g, which was not statistically different from that of NLS, 5.25 +/- 2.19 ml/g, nor from that of normal subcutaneous tissue, 4.98 +/- 1.04 ml/g. Calculations of the SBF using the obtained lambda values gave a significantly higher SBF in LS, 3.57 +/- 0.23 ml/100 g/min, compared to SBF in the NLS, 2.94 +/- 0.37 ml/100 g/min. There was no statistically significant difference between SBF in NLS and SBF in the normal subjects. The increased SBF in LS of psoriatics might be a secondary phenomenon to an increased heat loss in the lesional skin

  6. Cervicofacial and mediastinal emphysema due to a dental procedure

    Directory of Open Access Journals (Sweden)

    Mityanand Ramnarine

    2017-01-01

    Full Text Available Dental procedures, though commonplace and usually very safe, are not without complications. We report on a case of extensive cervicofacial and mediastinal emphysema after a routine dental procedure, initially masquerading as an allergic reaction in an otherwise young and healthy woman. A review of the relevant literature on this clinical entity is presented, which serves to underscore the need for awareness by the treating clinician of this condition and its potential sequela.

  7. Preferential binding of lysozyme to elastic fibres in pulmonary emphysema

    OpenAIRE

    Shteyngart, B.; Chaiwiriyakul, S.; Wong, J.; Cantor, J.

    1998-01-01

    BACKGROUND—Lysozyme is increased in inflammatory reactions and is a component of the extracellular matrix, but its possible role in lung diseases such as emphysema and interstitial fibrosis has not been investigated.
METHODS—To characterise differences in lysozyme content among normal, emphysematous, and fibrotic human lungs, tissue sections obtained from necropsy specimens were immunostained with rabbit polyclonal anti-human lysozyme antibody using the labelled streptavi...

  8. Atypical back pain in a child: subcutaneous lumbar abscess ...

    African Journals Online (AJOL)

    ... potentially life-threatening musculoskeletal complications. We discuss the extremely unusual case of a child with an extensive subcutaneous lumbar abcess who presented with severe back pain associated with active chickenpox infection. Keywords: abscess, back pain, chickenpox, group A β-haemolytic streptococcus, ...

  9. Continuous subcutaneous insulin infusion in neonatal diabetes mellitus.

    Science.gov (United States)

    Wintergerst, Kupper A; Hargadon, Susan; Hsiang, Helen Y

    2004-12-01

    A 1.2-kg premature baby boy with severe intrauterine growth retardation developed diabetes on d 2 of life. The computed tomography scan of the pancreas failed to show the tail, indicating agenesis of the dorsal anlage. Continuous subcutaneous insulin infusion (CSII) had been used for the subsequent 26 months. Complications, such as hypoglycemia, were minimal.

  10. Treatment with subcutaneous and transdermal fentanyl: results from a population pharmacokinetic study in cancer patients

    NARCIS (Netherlands)

    Oosten, A.W.; Abrantes, J.A.; Jonsson, S.; Bruijn, P. de; Kuip, E.J.M.; Falcao, A.; Rijt, C.C. van der; Mathijssen, R.H.

    2016-01-01

    PURPOSE: Transdermal fentanyl is effective for the treatment of moderate to severe cancer-related pain but is unsuitable for fast titration. In this setting, continuous subcutaneous fentanyl may be used. As data on the pharmacokinetics of continuous subcutaneous fentanyl are lacking, we studied the

  11. Treatment with subcutaneous and transdermal fentanyl: Results from a population pharmacokinetic study in cancer patients

    NARCIS (Netherlands)

    A.W. Oosten (Astrid); J.A. Abrantes (João A.); S. Jönsson (Siv); P. de Bruijn (Peter); E.J.M. Kuip (Evelien); A. Falcão (Amílcar); C.C.D. van der Rijt (Carin); A.H.J. Mathijssen (Ron)

    2016-01-01

    textabstractPurpose: Transdermal fentanyl is effective for the treatment of moderate to severe cancer-related pain but is unsuitable for fast titration. In this setting, continuous subcutaneous fentanyl may be used. As data on the pharmacokinetics of continuous subcutaneous fentanyl are lacking, we

  12. Bacteriological incidence in pneumonia patients with pulmonary emphysema: a bacterial floral analysis using the 16S ribosomal RNA gene in bronchoalveolar lavage fluid

    Directory of Open Access Journals (Sweden)

    Naito K

    2017-07-01

    Full Text Available Keisuke Naito,1 Kei Yamasaki,1 Kazuhiro Yatera,1 Kentaro Akata,1 Shingo Noguchi,1 Toshinori Kawanami,1 Kazumasa Fukuda,2 Takashi Kido,1 Hiroshi Ishimoto,3 Hiroshi Mukae3 1Department of Respiratory Medicine, 2Department of Microbiology, University of Occupational and Environmental Health, Japan, Kitakyushu City, Fukuoka, 3Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki City, Nagasaki, Japan Abstract: Pulmonary emphysema is an important radiological finding in chronic obstructive pulmonary disease patients, but bacteriological differences in pneumonia patients according to the severity of emphysematous changes have not been reported. Therefore, we evaluated the bacteriological incidence in the bronchoalveolar lavage fluid (BALF of pneumonia patients using cultivation and a culture-independent molecular method. Japanese patients with community-acquired pneumonia (83 and healthcare-associated pneumonia (94 between April 2010 and February 2014 were evaluated. The BALF obtained from pneumonia lesions was evaluated by both cultivation and a molecular method. In the molecular method, ~600 base pairs of bacterial 16S ribosomal RNA genes in the BALF were amplified by polymerase chain reaction, and clone libraries were constructed. The nucleotide sequences of 96 randomly selected colonies were determined, and a homology search was performed to identify the bacterial species. A qualitative radiological evaluation of pulmonary emphysema based on chest computed tomography (CT images was performed using the Goddard classification. The severity of pulmonary emphysema based on the Goddard classification was none in 47.4% (84/177, mild in 36.2% (64/177, moderate in 10.2% (18/177, and severe in 6.2% (11/177. Using the culture-independent molecular method, Moraxella catarrhalis was significantly more frequently detected in moderate or severe emphysema patients than in patients with no or mild emphysematous changes. The

  13. Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Sinan Kahraman

    2013-01-01

    Full Text Available Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

  14. Treatment with subcutaneous and transdermal fentanyl: results from a population pharmacokinetic study in cancer patients.

    Science.gov (United States)

    Oosten, Astrid W; Abrantes, João A; Jönsson, Siv; de Bruijn, Peter; Kuip, Evelien J M; Falcão, Amílcar; van der Rijt, Carin C D; Mathijssen, Ron H J

    2016-04-01

    Transdermal fentanyl is effective for the treatment of moderate to severe cancer-related pain but is unsuitable for fast titration. In this setting, continuous subcutaneous fentanyl may be used. As data on the pharmacokinetics of continuous subcutaneous fentanyl are lacking, we studied the pharmacokinetics of subcutaneous and transdermal fentanyl. Furthermore, we evaluated rotations from the subcutaneous to the transdermal route. Fifty-two patients treated with subcutaneous and/or transdermal fentanyl for moderate to severe cancer-related pain participated. A population pharmacokinetic model was developed and evaluated using non-linear mixed-effects modelling. For rotations from subcutaneous to transdermal fentanyl, a 1:1 dose conversion ratio was used while the subcutaneous infusion was continued for 12 h (with a 50 % tapering after 6 h). A 6-h scheme with 50 % tapering after 3 h was simulated using the final model. A one-compartment model with first-order elimination and separate first-order absorption processes for each route adequately described the data. The estimated apparent clearance of fentanyl was 49.6 L/h; the absorption rate constant for subcutaneous and transdermal fentanyl was 0.0358 and 0.0135 h(-1), respectively. Moderate to large inter-individual and inter-occasion variability was found. Around rotation from subcutaneous to transdermal fentanyl, measured and simulated plasma fentanyl concentrations rose and increasing side effects were observed. We describe the pharmacokinetics of subcutaneous and transdermal fentanyl in one patient cohort and report several findings that are relevant for clinical practice. Further research is warranted to study the optimal scheme for rotations from the subcutaneous to the transdermal route.

  15. [Analysis of clinical features in patients with pneumoconiosis complicated with pulmonary emphysema].

    Science.gov (United States)

    Li, X; Dai, W R; Li, L; Liu, W F; Yang, Z X; Xie, L

    2017-11-20

    Objective: To investigate the clinical features of pneumoconiosis complicated with pulmo-nary emphysema. Methods: selected 868 patients with pneumoconiosis were selected from December 2015 to December 2016 in Hunan occupational disease prevention and treatment hospital. Collected the results of high-resolution spiral CT, arterial blood gas, ECG, pulmonary function and MRC score. The subjects were divided into pneumoconiosis complicated with pulmonary emphysema group and simple pneumoconiosis group accord-ing to the results of HRCT. The smoking, MRC score, pulmonary function, blood gas and complications were compared. Results: A total of 868 patients were enrolled in the study. Emphysema 232 people, accounting for 26.73%. The incidence of emphysema in the first phase of pneumoconiosis was 12.69%, and the incidence rate of emphysema in pneumoconiosis was 17.03%, The incidence of three Stage pneumoconiosis was highest, up to 60.76%, the incidence of emphysema increased with the increase of stages of pneumoconiosis ( P =0.000) .The smoking index of pneumoconiosis combined with emphysema group was significantly higher than that of simple pneumoconiosis group ( P emphysema group the FEV(1.0)%, FVC%, FEV(1.0)/FVC, DLCO%, oxygen partial pressure were significantly lower than that of simple pneumoconiosis group ( P ≤0.05) . The combined rate of Bullae of lung in pneumoconiosis complicated with pulmonary emphysema group was higher than that of simple pneumo-coniosis group ( P emphysema had heavier breathing difficulties, more serious pulmonary function and active endurance, the degree of hypoxia is more serious, and had a higher incidence of complications. The pul-monary function of pneumoconiosis complicated with pulmonary emphysema is not consistent with the typical CPFE.

  16. 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

  17. VALVULAR BRONCHIAL BLOCKING IN TREATMENT OF RELAPSING SPONTANEOUS PHEUMOTHORAX IN THE PATIENT WITH PARASEPTAL PULMONARY EMPHYSEMA

    Directory of Open Access Journals (Sweden)

    O. V. Lovacheva

    2014-01-01

    Full Text Available Spontaneous pneumothorax was treated by placing two endobronchial valves during rigid bronchoscopy under anesthesia in a patient with severe end-stage chronic obstructive pulmonary disease (an emphysematous phenotype and overall paraseptal emphysema in the presence of grade III respiratory failure, with complicated spontaneous pneumothorax recurring manifold even after surgical treatment for spontaneous pneumothorax. This gave rise to the expansion of the lung that had collapsed within 18 months, to healing of bronchopleural fistula, and to return to normal life.The duration of a follow-up was 1 year with the valves being present in the bronchi and another year after their removal; there was no recurrence of spontaneous pneumothorax. Examination of respiratory function established significant positive changes (forced expiratory volume, vital capacity, and forced vital capacity after one year, then after removal of endobronchial valves. There were more significant positive changes in blood gas composition: normalization of blood oxygen saturation was achieved. 

  18. Browning of Subcutaneous White Adipose Tissue in Humans

    OpenAIRE

    Sidossis, Labros S.; Porter, Craig; Saraf, Manish K.; Børsheim, Elisabet; Radhakrishnan, Ravi S.; Chao, Tony; Ali, Arham; Chondronikola, Maria; Mlcak, Ronald; Finnerty, Celeste C.; Hawkins, Hal K.; Toliver-Kinsky, Tracy; Herndon, David N.

    2015-01-01

    Since the presence of brown adipose tissue (BAT) was confirmed in adult humans, BAT has become a therapeutic target for obesity and insulin resistance. We examined whether human subcutaneous white adipose tissue (sWAT) can adopt a BAT-like phenotype using a clinical model of prolonged and severe adrenergic stress. sWAT samples were collected from severely burned and healthy individuals. A subset of burn victims were prospectively followed during their acute hospitalization. Browning of sWAT w...

  19. Pulmonary interstitial emphysema: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mauricio Kauark Amoedo

    2013-09-01

    Full Text Available Pulmonary interstitial emphysema is a rare condition that generally affects low-weight preterm infants submitted to mechanical ventilation. The prognosis is variable, depending on early diagnosis and treatment. The radiologist plays a key role in this scenario. The authors report a case of persistent pulmonary interstitial emphysema, describing the main characteristics of such entity.

  20. Usefulness evaluation of low-dose for emphysema: Compared with high-resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Jeong [Dept. of Radiological Technology, Daejeon Health Institute of Technology, Daejeon (Korea, Republic of)

    2016-09-15

    The purpose of this study was to evaluate the usefulness of low-dose CT (LDCT) for emphysema compared with high-resolution CT (HRCT). Measurements of radiation dose and noise were repeated 3 times in same exposure condition which was similar with obtaining HRCT and LDCT images. We analysed reading results of 146 subjects. Six images per participants selected for emphysema grading. Emphysema was graded for all 6 zones on the left and right sides of the lungs by the consensus reading of two chest radiologists using a 4-point scale. Between the HRCT and LDCT images, diagnostic differences and agreements for emphysema were analyzed by McNemar's and unweighted kappa tests, and radiation doses and noise by a Mann-Whitney U-test, using the SPSS 19.0 program. Radiation dose from HRCT was significantly higher than that of LDCT, but the noise was significantly lower in HRCT than in LDCT. Diagnostic agreement for emphysema between HRCT and LDCT images was excellent (k-value=0.88). Emphysema grading scores were not significantly different between HRCT and LDCT images for all six lung zones. Emphysema grading scores from LDCT images were significantly correlated with increased scores on HRCT images (r=0.599, p < 0.001). Considering the tradeoff between radiation dose and image noise, LDCT could be used as the gold standard method instead of HRCT for emphysema detection and grading.

  1. Quality of life before and after lung transplantation in patients with emphysema versus other indications

    NARCIS (Netherlands)

    TenVergert, EM; Vermeulen, KM; van Enckevort, PJ

    2001-01-01

    Whether lung transplantation improves Health-related Quality of Life in patients with emphysema and other end-stage lung diseases before and after lung transplantation was examined. Between 1992 and 1999, 23 patients with emphysema and 19 patients with other indications completed self-administered

  2. Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms

    DEFF Research Database (Denmark)

    Grydeland, Thomas B; Dirksen, Asger; Coxson, Harvey O

    2010-01-01

    There is limited knowledge about the relationship between respiratory symptoms and quantitative high-resolution computed tomography measures of emphysema and airway wall thickness.......There is limited knowledge about the relationship between respiratory symptoms and quantitative high-resolution computed tomography measures of emphysema and airway wall thickness....

  3. CT-quantified emphysema distribution is associated with lung function decline

    NARCIS (Netherlands)

    Hoesein, F.A.A.M.; Rikxoort, E.M. van; Ginneken, B. van; de Jong, P. A.; Prokop, M.; Lammers, J.W.; Zanen, P.

    2012-01-01

    Emphysema distribution is associated with COPD. It is however unknown whether CT-quantified emphysema distribution (upper/lower lobe) is associated with lung function decline in heavy (former) smokers.587 male participants underwent lung CT-scanning and pulmonary function testing at baseline and

  4. The presence and progression of emphysema in COPD as determined by CT scanning and biomarker expression

    DEFF Research Database (Denmark)

    Coxson, Harvey O; Dirksen, Asger; Edwards, Lisa D

    2013-01-01

    Emphysema is a key contributor to airflow limitation in chronic obstructive pulmonary disease (COPD) and can be quantified using CT scanning. We investigated the change in CT lung density in a longitudinal, international cohort of patients with COPD. We also explored the potential relation between...... emphysema and patient characteristics, and investigated if certain circulating biomarkers were associated with decline in CT lung density....

  5. Pulmonary interstitial emphysema: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Amoedo, Mauricio Kauark, E-mail: mauricioamoedo@gmail.com [Interventional Radiology, Hospital A.C. Camargo, Sao Paulo, SP (Brazil); Souza, Luciana Volpon Soares; Souza, Antonio Soares [Instituto de Radiodiagnostico Rio Preto (Ultra-X), Sao Jose do Rio Preto, SP (Brazil); Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto (Famerp), SP (Brazil); Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2013-09-15

    Pulmonary interstitial emphysema is a rare condition that generally affects low-weight preterm infants submitted to mechanical ventilation. The prognosis is variable, depending on early diagnosis and treatment. The radiologist plays a key role in this scenario. The authors report a case of persistent pulmonary interstitial emphysema, describing the main characteristics of such entity. (author)

  6. Emphysema- and airway-dominant COPD phenotypes defined by standardised quantitative computed tomography.

    Science.gov (United States)

    Subramanian, Deepak R; Gupta, Sumit; Burggraf, Dorothe; Vom Silberberg, Suzan J; Heimbeck, Irene; Heiss-Neumann, Marion S; Haeussinger, Karl; Newby, Chris; Hargadon, Beverley; Raj, Vimal; Singh, Dave; Kolsum, Umme; Hofer, Thomas P; Al-Shair, Khaled; Luetzen, Niklas; Prasse, Antje; Müller-Quernheim, Joachim; Benea, Giorgio; Leprotti, Stefano; Boschetto, Piera; Gorecka, Dorota; Nowinski, Adam; Oniszh, Karina; Castell, Wolfgang Zu; Hagen, Michael; Barta, Imre; Döme, Balázs; Strausz, Janos; Greulich, Timm; Vogelmeier, Claus; Koczulla, Andreas R; Gut, Ivo; Hohlfeld, Jens; Welte, Tobias; Lavae-Mokhtari, Mahyar; Ziegler-Heitbrock, Loems; Brightling, Christopher; Parr, David G

    2016-07-01

    EvA (Emphysema versus Airway disease) is a multicentre project to study mechanisms and identify biomarkers of emphysema and airway disease in chronic obstructive pulmonary disease (COPD). The objective of this study was to delineate objectively imaging-based emphysema-dominant and airway disease-dominant phenotypes using quantitative computed tomography (QCT) indices, standardised with a novel phantom-based approach.441 subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-3) were assessed in terms of clinical and physiological measurements, laboratory testing and standardised QCT indices of emphysema and airway wall geometry.QCT indices were influenced by scanner non-conformity, but standardisation significantly reduced variability (p<0.001) and led to more robust phenotypes. Four imaging-derived phenotypes were identified, reflecting "emphysema-dominant", "airway disease-dominant", "mixed" disease and "mild" disease. The emphysema-dominant group had significantly higher lung volumes, lower gas transfer coefficient, lower oxygen (PO2 ) and carbon dioxide (PCO2 ) tensions, higher haemoglobin and higher blood leukocyte numbers than the airway disease-dominant group.The utility of QCT for phenotyping in the setting of an international multicentre study is improved by standardisation. QCT indices of emphysema and airway disease can delineate within a population of patients with COPD, phenotypic groups that have typical clinical features known to be associated with emphysema-dominant and airway-dominant disease. Copyright ©ERS 2016.

  7. Quantification of lung fibrosis and emphysema in mice using automated micro-computed tomography.

    Directory of Open Access Journals (Sweden)

    Ellen De Langhe

    Full Text Available BACKGROUND: In vivo high-resolution micro-computed tomography allows for longitudinal image-based measurements in animal models of lung disease. The combination of repetitive high resolution imaging with fully automated quantitative image analysis in mouse models of lung fibrosis lung benefits preclinical research. This study aimed to develop and validate such an automated micro-computed tomography analysis algorithm for quantification of aerated lung volume in mice; an indicator of pulmonary fibrosis and emphysema severity. METHODOLOGY: Mice received an intratracheal instillation of bleomycin (n = 8, elastase (0.25 U elastase n = 9, 0.5 U elastase n = 8 or saline control (n = 6 for fibrosis, n = 5 for emphysema. A subset of mice was scanned without intervention, to evaluate potential radiation-induced toxicity (n = 4. Some bleomycin-instilled mice were treated with imatinib for proof of concept (n = 8. Mice were scanned weekly, until four weeks after induction, when they underwent pulmonary function testing, lung histology and collagen quantification. Aerated lung volumes were calculated with our automated algorithm. PRINCIPAL FINDINGS: Our automated image-based aerated lung volume quantification method is reproducible with low intra-subject variability. Bleomycin-treated mice had significantly lower scan-derived aerated lung volumes, compared to controls. Aerated lung volume correlated with the histopathological fibrosis score and total lung collagen content. Inversely, a dose-dependent increase in lung volume was observed in elastase-treated mice. Serial scanning of individual mice is feasible and visualized dynamic disease progression. No radiation-induced toxicity was observed. Three-dimensional images provided critical topographical information. CONCLUSIONS: We report on a high resolution in vivo micro-computed tomography image analysis algorithm that runs fully automated and allows quantification of aerated lung volume in mice. This

  8. Quantitative assessment of smoking-induced emphysema progression in longitudinal CT screening for lung cancer

    Science.gov (United States)

    Suzuki, H.; Mizuguchi, R.; Matsuhiro, M.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.; Moriyama, N.

    2015-03-01

    Computed tomography has been used for assessing structural abnormalities associated with emphysema. It is important to develop a robust CT based imaging biomarker that would allow quantification of emphysema progression in early stage. This paper presents effect of smoking on emphysema progression using annual changes of low attenuation volume (LAV) by each lung lobe acquired from low-dose CT images in longitudinal screening for lung cancer. The percentage of LAV (LAV%) was measured after applying CT value threshold method and small noise reduction. Progression of emphysema was assessed by statistical analysis of the annual changes represented by linear regression of LAV%. This method was applied to 215 participants in lung cancer CT screening for five years (18 nonsmokers, 85 past smokers, and 112 current smokers). The results showed that LAV% is useful to classify current smokers with rapid progression of emphysema (0.2%/year, pemphysema in CT screening for lung cancer.

  9. Sex differences in emphysema and airway disease in smokers

    DEFF Research Database (Denmark)

    Camp, Pat G; Coxson, Harvey O; Levy, Robert D

    2009-01-01

    -resolution CT (HRCT) scanning in male and female smokers with and without COPD. METHODS: All subjects completed spirometry and answered an epidemiologic respiratory questionnaire. Inspiratory HRCT scans were obtained on 688 smokers enrolled in a family-based study of COPD. Emphysema was assessed by using...... by calculating the square root of the airway wall area (SQRTWA) and the percentage of the total airway area taken by the airway wall (WA%) relative to the internal perimeter. RESULTS: Women had a similar FEV(1) (women, 65.5% +/- 31.9% predicted; men, 62.1% +/- 30.4% predicted; p = 0.16) but fewer pack...

  10. Facilitated subcutaneous immunoglobulin administration (fSCIg)

    DEFF Research Database (Denmark)

    Blau, Igor-Wolfgang; Conlon, Niall; Petermann, Robert

    2016-01-01

    and diverse medical needs that treatments for SID management should strive to meet. In this special report, we study the opportunities provided by facilitated subcutaneous immunoglobulin administration (fSCIg) to treat patients for whom the conventional routes (intravenous and subcutaneous) are sub...

  11. "Extended subcutaneous route" technique: a quick subcutaneous tunnelling technique for PICC insertion.

    Science.gov (United States)

    Elli, Stefano; Abbruzzese, Chiara; Cannizzo, Luigi; Vimercati, Simona; Vanini, Stefania; Lucchini, Alberto

    2017-05-15

    To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the "extended subcutaneous route" technique. The "extended subcutaneous route" technique is described step by step. In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed. Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.

  12. Unusual case of life threatening subcutaneous hemorrhage in a blunt trauma patient

    Directory of Open Access Journals (Sweden)

    Ashraf F. Hefny

    2015-01-01

    Conclusion: Bleeding into the subcutaneous plane in closed degloving injury can cause severe hypovolemic shock. It is important for the clinicians managing trauma patients to be aware this serious injury.

  13. FAST: Towards safe and effective subcutaneous immunotherapy of persistent life-threatening food allergies

    NARCIS (Netherlands)

    Zuidmeer-Jongejan, Laurian; Fernandez-Rivas, Montserrat; Poulsen, Lars K.; Neubauer, Angela; Asturias, Juan; Blom, Lars; Boye, Joyce; Bindslev-Jensen, Carsten; Clausen, Michael; Ferrara, Rosa; Garosi, Paula; Huber, Hans; Jensen, Bettina M.; Koppelman, Stef; Kowalski, Marek L.; Lewandowska-Polak, Anna; Linhart, Birgit; Maillere, Bernard; Mari, Adriano; Martinez, Alberto; Mills, Clare En; Nicoletti, Claudio; Opstelten, Dirk-Jan; Papadopoulos, Nikos G.; Portoles, Antonio; Rigby, Neil; Scala, Enrico; Schnoor, Heidi J.; Sigursdottir, Sigurveig; Stavroulakis, Georg; Stolz, Frank; Swoboda, Ines; Valenta, Rudolf; van den Hout, Rob; Versteeg, Serge A.; Witten, Marianne; van Ree, Ronald

    2012-01-01

    ABSTRACT: The FAST project (Food Allergy Specific Immunotherapy) aims at the development of safe and effective treatment of food allergies, targeting prevalent, persistent and severe allergy to fish and peach. Classical allergen-specific immunotherapy (SIT), using subcutaneous injections with

  14. Automated diagnosis of interstitial lung diseases and emphysema in MDCT imaging

    Science.gov (United States)

    Fetita, Catalin; Chang Chien, Kuang-Che; Brillet, Pierre-Yves; Prêteux, Françoise

    2007-09-01

    Diffuse lung diseases (DLD) include a heterogeneous group of non-neoplasic disease resulting from damage to the lung parenchyma by varying patterns of inflammation. Characterization and quantification of DLD severity using MDCT, mainly in interstitial lung diseases and emphysema, is an important issue in clinical research for the evaluation of new therapies. This paper develops a 3D automated approach for detection and diagnosis of diffuse lung diseases such as fibrosis/honeycombing, ground glass and emphysema. The proposed methodology combines multi-resolution 3D morphological filtering (exploiting the sup-constrained connection cost operator) and graph-based classification for a full characterization of the parenchymal tissue. The morphological filtering performs a multi-level segmentation of the low- and medium-attenuated lung regions as well as their classification with respect to a granularity criterion (multi-resolution analysis). The original intensity range of the CT data volume is thus reduced in the segmented data to a number of levels equal to the resolution depth used (generally ten levels). The specificity of such morphological filtering is to extract tissue patterns locally contrasting with their neighborhood and of size inferior to the resolution depth, while preserving their original shape. A multi-valued hierarchical graph describing the segmentation result is built-up according to the resolution level and the adjacency of the different segmented components. The graph nodes are then enriched with the textural information carried out by their associated components. A graph analysis-reorganization based on the nodes attributes delivers the final classification of the lung parenchyma in normal and ILD/emphysematous regions. It also makes possible to discriminate between different types, or development stages, among the same class of diseases.

  15. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT

    International Nuclear Information System (INIS)

    Joegi, Jonas; Bajc, Marika; Ekberg, Marie; Jonson, Bjoern; Bozovic, Gracijela

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV 1 ). FEV 1 does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV 1 , symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p < 0.0001) and spirometric lung function (r = 0.62-0.74, p < 0.0005). The correlation between emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be reported. V

  16. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Joegi, Jonas; Bajc, Marika [Lund University, Skaane University Hospital, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Ekberg, Marie [Lund University, Skaane University Hospital, Department of Respiratory Medicine and Allergology, Institution of Clinical Sciences, Lund (Sweden); Jonson, Bjoern [Lund University, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Bozovic, Gracijela [Lund University, Skaane University Hospital, Department of Radiology, Institution of Clinical Sciences, Lund (Sweden)

    2011-07-15

    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV{sub 1}). FEV{sub 1} does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV{sub 1}, symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p < 0.0001) and spirometric lung function (r = 0.62-0.74, p < 0.0005). The correlation between emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be

  17. Online Feature Selection for Classifying Emphysema in HRCT Images

    Directory of Open Access Journals (Sweden)

    M. Prasad

    2008-06-01

    Full Text Available Feature subset selection, applied as a pre- processing step to machine learning, is valuable in dimensionality reduction, eliminating irrelevant data and improving classifier performance. In the classic formulation of the feature selection problem, it is assumed that all the features are available at the beginning. However, in many real world problems, there are scenarios where not all features are present initially and must be integrated as they become available. In such scenarios, online feature selection provides an efficient way to sort through a large space of features. It is in this context that we introduce online feature selection for the classification of emphysema, a smoking related disease that appears as low attenuation regions in High Resolution Computer Tomography (HRCT images. The technique was successfully evaluated on 61 HRCT scans and compared with different online feature selection approaches, including hill climbing, best first search, grafting, and correlation-based feature selection. The results were also compared against ldensity maskr, a standard approach used for emphysema detection in medical image analysis.

  18. Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening

    Energy Technology Data Exchange (ETDEWEB)

    Sverzellati, Nicola; Rastelli, Andrea; Schembri, Valentina; Filippo, Massimo de [University of Parma, Department of Clinical Sciences, Section of Radiology, Parma (Italy); Chetta, Alfredo [University of Parma, Department of Clinical Sciences, Section of Respiratory Diseases, Parma (Italy); Fasano, Luca; Pacilli, Angela Maria [Policlinico Sant' Orsola-Malpighi, Unita Operativa di Fisiopatologia Respiratoria, Bologna (Italy); Di Scioscio, Valerio; Bartalena, Tommaso; Zompatori, Maurizio [University of Bologna, Department of Radiology, Cardiothoracic Institute, Policlinico S.Orsola-Malpighi, Bologna (Italy)

    2009-07-15

    The aim of this study was to determine the prevalence of airway malacia and its relationship with ancillary morphologic features in patients with chronic obstructive pulmonary disease (COPD). A retrospective review was performed of a consecutive series of patients with COPD who were imaged with inspiratory and dynamic expiratory multidetector computed tomography (MDCT). Airway malacia was defined as {>=}50% expiratory reduction of the airway lumen. Both distribution and morphology of airway malacia were assessed. The extent of emphysema, extent of bronchiectasis and severity of bronchial wall thickness were quantified. The final study cohort was comprised of 71 patients. Airway malacia was seen in 38 of 71 patients (53%), and such proportion was roughly maintained in each stage of COPD severity. Almost all tracheomalacia cases (23/25, 92%) were characterised by an expiratory anterior bowing of the posterior membranous wall. Both emphysema and bronchiectasis extent did not differ between patients with and without airway malacia (p > 0.05). Bronchial wall thickness severity was significantly higher in patients with airway malacia and correlated with the degree of maximal bronchial collapse (p < 0.05). In conclusion, we demonstrated a strong association between airway malacia and COPD, disclosing a significant relationship with bronchial wall thickening. (orig.)

  19. The protective effect of PRMT6 overexpression on cigarette smoke extract-induced murine emphysema model

    Directory of Open Access Journals (Sweden)

    He X

    2017-11-01

    . Inflammation, apoptosis, and oxidative stress levels were severe in the CSE-treated emphysema mice compared with the control group, which was inhibited by the overexpression of PRMT6.Conclusion: The overexpression of PRMT6 might inhibit inflammation, apoptosis, and oxidative stress in CSE-induced emphysema mediated by H3R2me2a. Keywords: COPD, cigarette smoke extract, inflammation, apoptosis, oxidative stress, PRMT6

  20. Progression of emphysema evaluated by MRI using hyperpolarized (3)He (HP (3)He) measurements in patients with alpha-1-antitrypsin (A1AT) deficiency compared with CT and lung function tests

    DEFF Research Database (Denmark)

    Stavngaard, T; Søgaard, L Vejby; Batz, M

    2009-01-01

    as compared to yearly decline. PURPOSE: To investigate the progression of emphysema over a period of 2 years using diffusion-weighted hyperpolarized (HP) (3)He magnetic resonance imaging (MRI) in patients with alpha-1-antitrypsin (A1AT) deficiency. MATERIAL AND METHODS: Nine patients with severe A1AT...

  1. Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis.

    Science.gov (United States)

    Cottin, Vincent; Hansell, David M; Sverzellati, Nicola; Weycker, Derek; Antoniou, Katerina M; Atwood, Mark; Oster, Gerry; Kirchgaessler, Klaus-Uwe; Collard, Harold R; Wells, Athol U

    2017-11-01

    Patients with idiopathic pulmonary fibrosis and emphysema may have artificially preserved lung volumes. In this post hoc analysis, we investigated the relationship between baseline emphysema and fibrosis extents, as well as pulmonary function changes, over 48 weeks. Data were pooled from two phase III, randomized, double-blind, placebo-controlled trials of IFN-γ-1b in idiopathic pulmonary fibrosis (GIPF-001 [NCT00047645] and GIPF-007 [NCT00075998]). Patients with Week 48 data, baseline high-resolution computed tomographic images, and FEV 1 /FVC ratios less than 0.8 or greater than 0.9 (0.9 in GIPF-007), as well as randomly selected patients with ratios of 0.8-0.9 and 0.7-0.8, were included. Changes from baseline in pulmonary function at Week 48 were analyzed by emphysema extent. The relationship between emphysema and fibrosis extents and change in pulmonary function was assessed using multivariate linear regression. Emphysema was identified in 38% of patients. A negative correlation was observed between fibrosis and emphysema extents (r = -0.232; P pulmonary fibrosis and emphysema extent greater than or equal to 15%.

  2. Critical role of tumor necrosis factor receptor 1 in the pathogenesis of pulmonary emphysema in mice.

    Science.gov (United States)

    Fujita, Masaki; Ouchi, Hiroshi; Ikegame, Satoshi; Harada, Eiji; Matsumoto, Takemasa; Uchino, Junji; Nakanishi, Yoichi; Watanabe, Kentaro

    2016-01-01

    COPD is a major cause of chronic morbidity and mortality throughout the world. Although tumor necrosis factor-α (TNF-α) has a critical role in the development of COPD, the role of different TNF receptors (TNFRs) in pulmonary emphysema has not been resolved. We aimed to clarify the role of TNFRs in the development of pulmonary emphysema. TNF-α transgenic mice, a murine model of COPD in which the mice spontaneously develop emphysema with a large increase in lung volume and pulmonary hypertension, were crossed with either TNFR1-deficient mice or TNFR2-deficient mice. After 6 months, the gross appearance of the lung, lung histology, and pulmonary and cardiac physiology were determined. In addition, the relationship between apoptosis and emphysema was investigated. Pulmonary emphysema-like changes disappeared with deletion of TNFR1. However, slight improvements were attained with deletion of TNFR2. Apoptotic cells in the interstitium of the lung were observed in TNF-α transgenic mice. The apoptotic signals through TNFR1 appear critical for the pathogenesis of pulmonary emphysema. In contrast, the inflammatory process has a less important role for the development of emphysema.

  3. Massive Preperitoneal Hematoma after a Subcutaneous Injection

    Directory of Open Access Journals (Sweden)

    Hideki Katagiri

    2016-01-01

    Full Text Available Preperitoneal hematomas are rare and can develop after surgery or trauma. A 74-year-old woman, receiving systemic anticoagulation, developed a massive preperitoneal hematoma after a subcutaneous injection of teriparatide using a 32-gauge, 4 mm needle. In this patient, there were two factors, the subcutaneous injection of teriparatide and systemic anticoagulation, associated with development of the hematoma. These two factors are especially significant, because they are widely used clinically. Although extremely rare, physicians must consider this potentially life-threatening complication after subcutaneous injections, especially in patients receiving anticoagulation.

  4. Subcutaneous growth of human acoustic schwannomas in athymic nude mice

    DEFF Research Database (Denmark)

    Charabi, S.; Rygaard, J.; Klinken, Leif

    1994-01-01

    Neuropathology, acoustic schwannomas, subcutaneous implantation, nude mouse, growth, pcna, ki-67......Neuropathology, acoustic schwannomas, subcutaneous implantation, nude mouse, growth, pcna, ki-67...

  5. Quantitative computed tomography of lung parenchyma in patients with emphysema: analysis of higher-density lung regions

    Science.gov (United States)

    Lederman, Dror; Leader, Joseph K.; Zheng, Bin; Sciurba, Frank C.; Tan, Jun; Gur, David

    2011-03-01

    Quantitative computed tomography (CT) has been widely used to detect and evaluate the presence (or absence) of emphysema applying the density masks at specific thresholds, e.g., -910 or -950 Hounsfield Unit (HU). However, it has also been observed that subjects with similar density-mask based emphysema scores could have varying lung function, possibly indicating differences of disease severity. To assess this possible discrepancy, we investigated whether density distribution of "viable" lung parenchyma regions with pixel values > -910 HU correlates with lung function. A dataset of 38 subjects, who underwent both pulmonary function testing and CT examinations in a COPD SCCOR study, was assembled. After the lung regions depicted on CT images were automatically segmented by a computerized scheme, we systematically divided the lung parenchyma into different density groups (bins) and computed a number of statistical features (i.e., mean, standard deviation (STD), skewness of the pixel value distributions) in these density bins. We then analyzed the correlations between each feature and lung function. The correlation between diffusion lung capacity (DLCO) and STD of pixel values in the bin of -910HU lung parenchyma and lung function, which indicates that similar to the conventional density mask method, the pixel value distribution features in "viable" lung parenchyma areas may also provide clinically useful information to improve assessments of lung disease severity as measured by lung functional tests.

  6. Regional Emphysema Score Predicting Overall Survival, Quality of Life, and Pulmonary Function Recovery in Early-Stage Lung Cancer Patients.

    Science.gov (United States)

    Dai, Jie; Liu, Ming; Swensen, Stephen J; Stoddard, Shawn M; Wampfler, Jason A; Limper, Andrew H; Jiang, Gening; Yang, Ping

    2017-05-01

    Pulmonary emphysema is a frequent comorbidity in lung cancer, but its role in tumor prognosis remains obscure. Our aim was to evaluate the impact of the regional emphysema score (RES) on a patient's overall survival, quality of life (QOL), and recovery of pulmonary function in stage I to II lung cancer. Between 1997 and 2009, a total of 1073 patients were identified and divided into two surgical groups-cancer in the emphysematous (group 1 [n = 565]) and nonemphysematous (group 2 [n = 435]) regions-and one nonsurgical group (group 3 [n = 73]). RES was derived from the emphysematous region and categorized as mild (≤5%), moderate (6%-24%), or severe (25%-60%). In group 1, patients with a moderate or severe RES experienced slight decreases in postoperative forced expiratory volume in 1 second, but increases in the ratio of forced expiratory volume in 1 second to forced vital capacity compared with those with a mild RES (p lung function. RES is also predictive of posttreatment QOL related to dyspnea in early-stage lung cancer. In both surgical groups, RES is an independent predictor of survival. Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  7. Injection site reactions after subcutaneous oligonucleotide therapy

    NARCIS (Netherlands)

    van Meer, L. (Leonie); M. Moerland (Matthijs); Gallagher, J. (Jolie); M.B.A. van Doorn (Martijn); E.P. Prens (Errol); A.F. Cohen; Rissmann, R. (Robert); J. Burggraaf (Jacobus)

    2016-01-01

    textabstractOligonucleotides (ONs) are short fragments of nucleic acids, currently being investigated as therapeutic agents. When administered subcutaneously (sc), ONs cause a specific local reaction originating around the injection site, such as erythema, itching, discomfort and pain, including

  8. Subcutaneous nodule: A case of Dirofilaria

    Science.gov (United States)

    D’Souza, Reshmina; Jakribettu, Ramakrishna Pai; Sudharsana, Sunil H; Aithala, Sathyamoorthy P

    2013-01-01

    Human subcutaneous dirofilariasis is a rare helminthic infection. It is caused by filarial worms of the Genus Dirofilaria, which is the natural parasites of dogs, cats, foxes, and wild mammals. Zoonotic filariasis caused by Dirofilaria species is rarely seen in the region of Dakshina Kannada. Most of them are seen in patients who are along the border of the district which shares its boundary with the state of Kerala, where dirofilariasis is constantly reported to occur. Here, we report a case of subcutaneous dirofilariasis, presenting as a subcutaneous nodule on the left cheek of a 28-year-old male from Cochin (Ernakulam), Kerala, South India. Two live worms were recovered from the subcutaneous nodular swelling. PMID:23776842

  9. Removal of subcutaneous lipomas: Interest of liposuction.

    Science.gov (United States)

    Gaucher, Sonia; Maladry, David; Silitra, Ana Maria; Documet, David; Philippe, Henri-Jean

    2017-09-01

    Subcutaneous lipomas are very common tumors. We report our experience of treatment by liposuction in carefully selected patients, initially referred for conventional surgical excision. © 2017 Wiley Periodicals, Inc.

  10. Interferon Beta-1a Subcutaneous Injection

    Science.gov (United States)

    Interferon beta-1a subcutaneous injection is used to reduce episodes of symptoms and slow the development of disability in ... problems with vision, speech, and bladder control). Interferon beta-1a is in a class of medications called ...

  11. Primary Kaposi sarcoma of the subcutaneous tissue

    Directory of Open Access Journals (Sweden)

    Dezube Bruce J

    2008-09-01

    Full Text Available Abstract Background Involvement of the subcutis by Kaposi sarcoma (KS occurs primarily when cutaneous KS lesions evolve into deep penetrating nodular tumors. Primary KS of the subcutaneous tissue is an exceptional manifestation of this low-grade vascular neoplasm. Case presentation We present a unique case of acquired immune deficiency syndrome (AIDS-associated KS manifesting primarily in the subcutaneous tissue of the anterior thigh in a 43-year-old male, which occurred without overlying visible skin changes or concomitant KS disease elsewhere. Radiological imaging and tissue biopsy confirmed the diagnosis of KS. Conclusion This is the first documented case of primary subcutaneous KS occurring in the setting of AIDS. The differential diagnosis of an isolated subcutaneous lesion in an human immunodeficiency virus (HIV-infected individual is broad, and requires both imaging and a histopathological diagnosis to guide appropriate therapy.

  12. Recurrent, giant subcutaneous leiomyosarcoma of the thigh

    Directory of Open Access Journals (Sweden)

    Gao Chuanping, MD

    2015-10-01

    Full Text Available We present a case of recurrent, massive subcutaneous leiomyosarcoma involving the left thigh in a 29-year-old male from Madagascar. The patient had earlier undergone local resection of subcutaneous leiomyosarcoma a half year before. After surgical intervention, local recurrence developed at this site and was rapidly growing. The patient was surgically treated with a 2-cm-wide margin local excision in our hospital. The patient has remained recurrence free at 1-year follow-up.

  13. Cytological diagnosis of microfilariae in subcutaneous nodule

    Directory of Open Access Journals (Sweden)

    Narayanan K Panicker

    2012-01-01

    Full Text Available Microfilariaemia presenting with subcutaneous nodule is rare. We report a case of a 22-year-old female patient who presented with a subcutaneous nodule on right forearm. Fine-needle aspiration cytology from the nodule showed many sheathed motile microfilaria on wet mount preparation during day time. Wuchereria loa loa is known to be associated with soft tissue swellings as reported earlier. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa.

  14. Novel therapeutic approach for pulmonary emphysema using gelatin microspheres releasing basic fibroblast growth factor in a canine model.

    Science.gov (United States)

    Chang, Sung Soo; Yokomise, Hiroyasu; Matsuura, Natsumi; Gotoh, Masashi; Tabata, Yasuhiko

    2014-08-01

    The prognosis of patients with emphysema is poor as there is no truly effective treatment. Our previous study showed that the alveolar space was smaller and the microvessel density was higher in a canine emphysema model after the intrapulmonary arterial administration of gelatin microspheres slowly releasing basic fibroblast growth factor (bFGF-GMS). In the present study, we evaluated the functional effect of injecting bFGF-GMS via the pulmonary artery in this canine pulmonary emphysema model. Using the porcine pancreatic elastase (PPE)-induced total emphysema model, we approximated the value of lung compliance with a Power Lab System, and performed blood gas analysis in a control group, a total emphysema group, and a bFGF group in which bFGF-GMS were injected toward the whole pulmonary artery via the femoral vein. Each group comprised five dogs. Lung compliance was higher in the total emphysema group than in the control group (p = 0.031), and the bFGF group showed no significant improvement of lung compliance vs. the total emphysema group (p = 0.112). PaO2 (partial pressure of oxygen in arterial blood) was improved by administering bFGF-GMS in the total emphysema model (p = 0.027). In the canine total emphysema model, blood gas parameters were improved by the whole pulmonary arterial administration of bFGF-GMS. This method has the potential to be an effective novel therapy for pulmonary emphysema.

  15. Clinical Impact of Emphysema Evaluated by High-Resolution Computed Tomography on Idiopathic Pulmonary Fibrosis Diagnosed by Surgical Lung Biopsy.

    Science.gov (United States)

    Kohashi, Yasuo; Arai, Toru; Sugimoto, Chikatoshi; Tachibana, Kazunobu; Akira, Masanori; Kitaichi, Masanori; Hayashi, Seiji; Inoue, Yoshikazu

    2016-01-01

    The prognosis of combined cases of pulmonary fibrosis and emphysema is unresolved partially because radiological differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia is difficult in coexisting emphysema cases. The purpose of this study was to clarify the clinical impact of emphysema on the survival of patients with idiopathic pulmonary fibrosis (IPF). One hundred and seven patients with interstitial lung diseases were diagnosed by surgical lung biopsies between 2006 and 2012, and 47 patients were diagnosed with IPF through multidisciplinary discussion. Emphysema on high-resolution computed tomography scans was evaluated semiquantitatively by visual scoring. Eight out of the 47 IPF patients showed a higher emphysema score (>3) and were diagnosed to have IPF-emphysema. The median survival time of patients with IPF-emphysema (1,734 days) from the initial diagnosis was significantly shorter than that of patients with IPF alone (2,229 days) by Kaplan-Meier analysis (p = 0.007, log-rank test). Univariate Cox proportional hazard regression analyses revealed that a higher total emphysema score (>3.0) was a significantly poor prognostic factor in addition to Krebs von den Lungen-6, surfactant protein-D, arterial oxygen tension, percent forced vital capacity, and percent diffusing capacity of carbon monoxide (%DLCO). Multivariate Cox proportional hazard regression analyses with the stepwise method showed that higher total emphysema score (>3) and %DLCO were significantly poor prognostic factors. The prognosis of IPF-emphysema was significantly worse than that of IPF alone. © 2016 S. Karger AG, Basel.

  16. Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man

    DEFF Research Database (Denmark)

    Bülow, J; Friberg, L; Gaardsting, O

    1985-01-01

    Cooling of the scalp has been found to prevent hair loss following cytostatic treatment, but in order to obtain the hair preserving effect the subcutaneous temperature has to be reduced below 22 degrees C. In order to establish the relationship between epicutaneous and subcutaneous temperatures...... epicutaneous and subcutaneous temperatures could be demonstrated with the regression equation: s = 0.9 c + 4.9 (r = 0.99). In eight of the 10 subjects the subcutaneous temperature could be reduced below 22 degrees C with the applied technique. It is concluded that the hair preserving effect of scalp cooling...

  17. Towards local progression estimation of pulmonary emphysema using CT

    Energy Technology Data Exchange (ETDEWEB)

    Staring, M., E-mail: m.staring@lumc.nl; Bakker, M. E.; Shamonin, D. P.; Reiber, J. H. C.; Stoel, B. C. [Department of Radiology, Division of Image Processing, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden (Netherlands); Stolk, J. [Department of Pulmonology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden (Netherlands)

    2014-02-15

    Purpose: Whole lung densitometry on chest CT images is an accepted method for measuring tissue destruction in patients with pulmonary emphysema in clinical trials. Progression measurement is required for evaluation of change in health condition and the effect of drug treatment. Information about the location of emphysema progression within the lung may be important for the correct interpretation of drug efficacy, or for determining a treatment plan. The purpose of this study is therefore to develop and validate methods that enable the local measurement of lung density changes, which requires proper modeling of the effect of respiration on density. Methods: Four methods, all based on registration of baseline and follow-up chest CT scans, are compared. The first naïve method subtracts registered images. The second employs the so-called dry sponge model, where volume correction is performed using the determinant of the Jacobian of the transformation. The third and the fourth introduce a novel adaptation of the dry sponge model that circumvents its constant-mass assumption, which is shown to be invalid. The latter two methods require a third CT scan at a different inspiration level to estimate the patient-specific density-volume slope, where one method employs a global and the other a local slope. The methods were validated on CT scans of a phantom mimicking the lung, where mass and volume could be controlled. In addition, validation was performed on data of 21 patients with pulmonary emphysema. Results: The image registration method was optimized leaving a registration error below half the slice increment (median 1.0 mm). The phantom study showed that the locally adapted slope model most accurately measured local progression. The systematic error in estimating progression, as measured on the phantom data, was below 2 gr/l for a 70 ml (6%) volume difference, and 5 gr/l for a 210 ml (19%) difference, if volume correction was applied. On the patient data an underlying

  18. Changes in transcutaneous oxygen tension during exercise in pulmonary emphysema.

    OpenAIRE

    Hughes, J A; Gray, B J; Hutchison, D C

    1984-01-01

    Continuous measurements of transcutaneous oxygen tension (tcPO2) were made in 23 patients with radiological evidence of emphysema, at rest and during a maximal progressive exercise test. tcPO2 during the final phase of exercise was compared with tcPO2 at rest; the mean change (exercising minus resting value) in tcPO2 (delta tcPO2) was -0.8 mm Hg (SD 10.5, range -18 to +25) (-0.1 kPa (SD 1.4, range -2.4 to +3.3]. delta tcPO2 was correlated with: resting arterial oxygen tension (PaO2) (r = 0.60...

  19. Lung Volume Reduction in Pulmonary Emphysema from the Radiologist's Perspective.

    Science.gov (United States)

    Doellinger, F; Huebner, R H; Kuhnigk, J M; Poellinger, A

    2015-08-01

    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. Today, surgical and various minimal invasive methods of lung volume reduction are in use. Radiological and nuclear medical examinations are helpful in the evaluation of an appropriate lung area. Imaging can detect periinterventional complications. Reduction of lung

  20. 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...

  1. [Pediatric orbital emphysema caused by a compressed-air pistol shot: a case report].

    Science.gov (United States)

    Navarro-Mingorance, A; Reyes-Dominguez, S B; León-León, M C

    2014-09-01

    We report the case of a 2 year-old child with orbital emphysema secondary to a compressed-air gun shot in the malar region, with no evidence of orbital wall fracture. Conservative treatment was applied, and no complications were observed. Orbital emphysema in the absence of an orbital wall fracture is a rare situation. Orbital emphysema is usually seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To our knowledge there have been very few reports of orbital emphysema caused by a compressed-air injury. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  2. COPD, emphysema and the onset of lung cancer. A systematic review.

    Science.gov (United States)

    Mouronte-Roibás, Cecilia; Leiro-Fernández, Virginia; Fernández-Villar, Alberto; Botana-Rial, Maribel; Ramos-Hernández, Cristina; Ruano-Ravina, Alberto

    2016-11-28

    Chronic Obstructive Pulmonary Disease (COPD) and emphysema have been described as possible risk factors for lung cancer. We aim to assess the relationship between COPD, emphysema and the onset of lung cancer. We have developed a systematic review of the published literature in order to systematically analyze the scientific evidence available on this association, applying predefined inclusion and exclusion criteria. 11 Studies were included. Both COPD and emphysema seem to increase the risk of developing lung cancer, being this risk higher for smokers with heavier tobacco consumption. These results emphasize the need for physicians to perform spirometries in current and former smokers and lung image tests when needed in order to identify COPD and emphysema and thus select patients at higher risk of developing lung cancer. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. β2-Microglobulin participates in development of lung emphysema by inducing lung epithelial cell senescence.

    Science.gov (United States)

    Gao, Na; Wang, Ying; Zheng, Chun-Ming; Gao, Yan-Li; Li, Hui; Li, Yan; Fu, Ting-Ting; Xu, Li-Li; Wang, Wei; Ying, Sun; Huang, Kewu

    2017-05-01

    β 2 -Microglobulin (β 2 M), the light chain of the major histocompatibility complex class I (MHC I), has been identified as a proaging factor and is involved in the pathogenesis of neurodegenerative disorders by driving cognitive and regenerative impairments. However, little attention has focused on the effect of β 2 M in the development of lung emphysema. Here, we found that concentrations of β 2 M in plasma were significantly elevated in patients with lung emphysema than those in normal control subjects (1.89 ± 0.12 vs. 1.42 ± 0.06 mg/l, P lung tissue of emphysema (39.90 ± 1.97 vs. 23.94 ± 2.11%, P lung emphysema through induction of lung epithelial cell senescence and inhibition. Copyright © 2017 the American Physiological Society.

  4. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    , CT scans were performed to determine emphysema (%LAA), airway wall thickness (AWT-Pi10), and lung mass. Muscle wasting based on FFMI was assessed by bioelectrical impedance. In both the men and women with COPD, FFMI was negatively associated with %LAA. FMI was positively associated with AWT-Pi10......The objective of the present study was to determine the association between CT phenotypes-emphysema by low attenuation area and bronchitis by airway wall thickness-and body composition parameters in a large cohort of subjects with and without COPD. In 452 COPD subjects and 459 subjects without COPD...... in both subjects with and without COPD. Among the subjects with muscle wasting, the percentage emphysema was high, but the predictive value was moderate. In conclusion, the present study strengthens the hypothesis that the subgroup of COPD cases with muscle wasting have emphysema. Airway wall thickness...

  5. Different proliferative capacity of lung fibroblasts obtained from control subjects and patients with emphysema

    NARCIS (Netherlands)

    Noordhoek, JA; Postma, DS; Chong, LL; Vos, JTWM; Kauffman, HF; Timens, W; van Straaten, JFM

    2003-01-01

    To characterize the possible role of a dysregulated proliferative capacity of pulmonary fibroblasts in insufficient tissue repair in lungs from patients with pulmonary emphysema, the authors undertook in vitro proliferative studies with pulmonary fibroblasts obtained from lung tissue of patients

  6. Pulmonary emphysema diagnosis using a preclinical small-animal X-ray dark-field scanner

    Energy Technology Data Exchange (ETDEWEB)

    Yaroshenko, Andre; Bech, Martin; Tapfer, Arne; Velroyen, Astrid; Pfeiffer, Franz [Department of Physics, Technische Universitaet Muenchen (Germany); Meinel, Felix; Nikolaou, Konstantin; Reiser, Maximilian [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Muenchen (Germany); Bohla, Alexander; Yildirim, Ali Oender; Eickelberg, Oliver [Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen (Germany)

    2013-07-01

    Pulmonary emphysema is one of the leading causes of morbidity and mortality worldwide that is difficult to detect using conventional x-ray radiographic methods. For emphysematous lungs with enlarged distal airspaces, x-ray scattering decreases and transmission increases, as has been demonstrated by the proof-of-principle experiments with brilliant x-rays from a synchrotron source. Therefore, combination of the transmission and dark-field signals leads to a novel diagnostic approach for pulmonary emphysema. In this study, images of excised murine lungs with pulmonary emphysema and control lungs were acquired using a compact phase- and dark-field scanner with a polychromatic source and a cone-beam geometry. The data analysis revealed a clear distinction between the two groups in the per-pixel scatter plot. The main difference was observed in the angle of the distribution to the vertical. The presented study reveals the high potential of the approach for the pulmonary emphysema diagnosis.

  7. Variation compensation and analysis on diaphragm curvature analysis for emphysema quantification on whole lung CT scans

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Barr, R. Graham; Yankelevitz, David F.; Henschke, Claudia I.

    2010-03-01

    CT scans allow for the quantitative evaluation of the anatomical bases of emphysema. Recently, a non-density based geometric measurement of lung diagphragm curvature has been proposed as a method for the quantification of emphysema from CT. This work analyzes variability of diaphragm curvature and evaluates the effectiveness of a compensation methodology for the reduction of this variability as compared to emphysema index. Using a dataset of 43 scan-pairs with less than a 100 day time-interval between scans, we find that the diaphragm curvature had a trend towards lower overall variability over emphysema index (95% CI:-9.7 to + 14.7 vs. -15.8 to +12.0), and that the variation of both measures was reduced after compensation. We conclude that the variation of the new measure can be considered comparable to the established measure and the compensation can reduce the apparent variation of quantitative measures successfully.

  8. Quantitative CT measures of emphysema and airway wall thickness are related to D(L)CO

    DEFF Research Database (Denmark)

    Grydeland, Thomas B; Thorsen, Einar; Dirksen, Asger

    2011-01-01

    There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness....

  9. Evaluation of pharmacokinetic model designs for subcutaneous infusion of insulin aspart

    DEFF Research Database (Denmark)

    Mansell, Erin J.; Schmidt, Signe; Docherty, Paul D.

    2017-01-01

    Effective mathematical modelling of continuous subcutaneous infusion pharmacokinetics should aid understanding and control in insulin therapy. Thorough analysis of candidate model performance is important for selecting the appropriate models. Eight candidate models for insulin pharmacokinetics...... included a range of modelled behaviours, parameters and complexity. The models were compared using clinical data from subjects with type 1 diabetes with continuous subcutaneous insulin infusion. Performance of the models was compared through several analyses: R2 for goodness of fit; the Akaike Information...

  10. Critical role of tumor necrosis factor receptor 1 in the pathogenesis of pulmonary emphysema in mice

    Directory of Open Access Journals (Sweden)

    Fujita M

    2016-07-01

    Full Text Available Masaki Fujita,1 Hiroshi Ouchi,2 Satoshi Ikegame,2 Eiji Harada,2 Takemasa Matsumoto,1 Junji Uchino,1 Yoichi Nakanishi,2 Kentaro Watanabe1 1Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, 2Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Abstract: COPD is a major cause of chronic morbidity and mortality throughout the world. Although tumor necrosis factor-α (TNF-α has a critical role in the development of COPD, the role of different TNF receptors (TNFRs in pulmonary emphysema has not been resolved. We aimed to clarify the role of TNFRs in the development of pulmonary emphysema. TNF-α transgenic mice, a murine model of COPD in which the mice spontaneously develop emphysema with a large increase in lung volume and pulmonary hypertension, were crossed with either TNFR1-deficient mice or TNFR2-deficient mice. After 6 months, the gross appearance of the lung, lung histology, and pulmonary and cardiac physiology were determined. In addition, the relationship between apoptosis and emphysema was investigated. Pulmonary emphysema-like changes disappeared with deletion of TNFR1. However, slight improvements were attained with deletion of TNFR2. Apoptotic cells in the interstitium of the lung were observed in TNF-α transgenic mice. The apoptotic signals through TNFR1 appear critical for the pathogenesis of pulmonary emphysema. In contrast, the inflammatory process has a less important role for the development of emphysema. Keywords: TNF-α, receptor, emphysema, apoptosis

  11. Smoking-related emphysema is associated with idiopathic pulmonary fibrosis and rheumatoid lung.

    Science.gov (United States)

    Antoniou, Katerina M; Walsh, Simon L; Hansell, David M; Rubens, Michael R; Marten, Katharina; Tennant, Rachel; Hansel, Trevor; Desai, Sujal R; Siafakas, Nikolaos M; du Bois, Roland M; Wells, Athol U

    2013-11-01

    A combined pulmonary fibrosis/emphysema syndrome has been proposed, but the basis for this syndrome is currently uncertain. The aim was to evaluate the prevalence of emphysema in idiopathic pulmonary fibrosis (IPF) and rheumatoid lung (rheumatoid arthritis-interstitial lung disease (RA-ILD)), and to compare the morphological features of lung fibrosis between smokers and non-smokers. Using high-resolution computed tomography, the prevalence of emphysema and the pack-year smoking histories associated with emphysema were compared between current/ex-smokers with IPF (n = 186) or RA-ILD (n = 46), and non-chronic obstructive pulmonary disease (COPD) controls (n = 103) and COPD controls (n = 34). The coarseness of fibrosis was compared between smokers and non-smokers. Emphysema, present in 66/186 (35%) patients with IPF and 22/46 (48%) smokers with RA-ILD, was associated with lower pack-year smoking histories than in control groups (P emphysema in IPF was positively linked to the pack-year smoking history (odds ratio 1.04, 95% confidence interval (CI) 1.02-1.06, P emphysema but did not differ significantly between smokers and non-smokers. In IPF and RA-ILD, a high prevalence of concurrent emphysema, in association with low pack-year smoking histories, and an association between coarser pulmonary fibrosis and a history of smoking in IPF together provide support for possible pathogenetic linkage to smoking in both diseases. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  12. Quantitative CT measures of emphysema and airway wall thickness are related to D(L)CO

    DEFF Research Database (Denmark)

    Grydeland, Thomas B; Thorsen, Einar; Dirksen, Asger

    2011-01-01

    There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness.......There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness....

  13. Implications of Emphysema and Lung Function for the Development of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Hong, Yoonki; Lee, Jae Seung; Yoo, Kwang Ha; Lee, Ji-Hyun; Kim, Woo Jin; Lim, Seong Yong; Rhee, Chin Kook; Lee, Sang-Do

    2016-01-01

    Background Chronic obstructive pulmonary disease (COPD) is sometimes complicated with pneumonia, but little is known about the risk factors that promote the development of pneumonia in COPD. These risk factors were evaluated in the present study. Methods The data of 324 patients with COPD from a prospective multi-center observational cohort with obstructive lung disease were evaluated retrospectively. To identify risk factors for the development of pneumonia in COPD, the clinical and radiological data at enrollment and the time to the first episode of pneumonia were analyzed by Cox proportional hazard analysis. Results The median follow-up time was 1,099 days and 28 patients (8.6%) developed pneumonia. The Cox analysis showed that post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted) and the computed tomography (CT) emphysema extent (inspiratory V950) were independent risk factors for the development of pneumonia (post-bronchodilator FEV1: hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.94–1.00; p=0.048 and inspiratory V950: HR, 1.04; 95% CI, 1.01–1.07; p=0.01). Conclusion Emphysema severity measured by CT and post-bronchodilator FEV1 are important risk factors for the development of pneumonia in COPD. PMID:27066086

  14. The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility.

    Science.gov (United States)

    Moser, J B; Mak, S M; McNulty, W H; Padley, S; Nair, A; Shah, P L; Devaraj, A

    2017-11-01

    To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  15. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers

    DEFF Research Database (Denmark)

    Wille, Mathilde Marie Winkler; Thomsen, Laura H.; Dirksen, Asger

    2014-01-01

    OBJECTIVES: To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort. METHODS: Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two...... observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed. RESULTS: Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p time-trends in both emphysema presence and grading were found (higher...... time-trends for emphysema presence and grading. • For continuous smokers, progression of emphysema was seen in all lung zones. • For former smokers, progression of emphysema was undetectable by visual assessment. • Onset and progression of interstitial abnormalities are visually detectable....

  16. Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man

    DEFF Research Database (Denmark)

    Bülow, J; Friberg, L; Gaardsting, O

    1985-01-01

    Cooling of the scalp has been found to prevent hair loss following cytostatic treatment, but in order to obtain the hair preserving effect the subcutaneous temperature has to be reduced below 22 degrees C. In order to establish the relationship between epicutaneous and subcutaneous temperatures d...

  17. Modelling the Molecular Transportation of Subcutaneously Injected Salubrinal

    Directory of Open Access Journals (Sweden)

    Andy Chen

    2011-01-01

    Full Text Available For the subcutaneous administration of a chemical agent (salubrinal, we constructed a mathematical model of molecule transportation and subsequently evaluated the kinetics of diffusion, convection, and molecular turnover. Salubrinal is a potential therapeutic agent that can reduce cellular damage and death. The understanding of its temporal profiles in local tissue as well as in a whole body is important to develop a proper strategy for its administration. Here, the diffusion and convection kinetics was formulated using partial and ordinary differential equations in one- and three-dimensional (semi-spherical coordinates. Several key parameters including an injection velocity, a diffusion coefficient, thickness of subcutaneous tissue, and a permeability factor at the tissue-blood boundary were estimated from experimental data in rats. With reference to analytical solutions in a simplified model without convection, numerical solutions revealed that the diffusion coefficient and thickness of subcutaneous tissue determined the timing of the peak concentration in the plasma, and its magnitude was dictated by the permeability factor. Furthermore, the initial velocity, induced by needle injection, elevated an immediate transport of salubrinal at t < 1h. The described analysis with a combination of partial and ordinary differential equations contributes to the prediction of local and systemic effects and the understanding of the transportation mechanism of salubrinal and other agents.

  18. Emphysema Is Common in Lungs of Cystic Fibrosis Lung Transplantation Patients: A Histopathological and Computed Tomography Study

    OpenAIRE

    Mets, Onno M.; Roothaan, Suzan M.; Bronsveld, Inez; Luijk, Bart; van de Graaf, Ed A.; Vink, Aryan; de Jong, Pim A.

    2015-01-01

    Background Lung disease in cystic fibrosis (CF) involves excessive inflammation, repetitive infections and development of bronchiectasis. Recently, literature on emphysema in CF has emerged, which might become an increasingly important disease component due to the increased life expectancy. The purpose of this study was to assess the presence and extent of emphysema in endstage CF lungs. Methods In explanted lungs of 20 CF patients emphysema was semi-quantitatively assessed on histology speci...

  19. Subcutaneous tissue flaps for hallux covering.

    Science.gov (United States)

    Vaienti, Luca; Urzola, Victor; Scotti, Andrea; Masetto, L

    2010-03-01

    With the understanding of the extensive vascular supply of the subcutaneous tissue, of its efficacy in the protection of the anatomical structures and of its capability of promoting the adequate functioning of very stressed regions of the human body, the use of subcutaneous adipose flaps has become a valid and sometimes the only reasonable therapeutic weapon in the treatment of small and medium-sized tissue loss. Such a defect represents a common complication of great toe injuries and surgery. Here subcutaneous flap reconstruction is proposed for the treatment of dorsal and medial soft tissue losses of the hallux complicated with infection. Two case are reported. To the best of the authors' knowledge, this application has not been reported in this anatomical site so far. The technique might be worth knowing both for orthopedic and plastic surgeons, as it may represent a safe, less invasive solution for most tegumentary problems of the dorso-medial side of the first ray.

  20. Hypertrophic Obesity and Subcutaneous Adipose Tissue Dysfunction

    Directory of Open Access Journals (Sweden)

    Anna Meiliana

    2014-08-01

    Full Text Available BACKGROUND: Over the past 50 years, scientists have recognized that not all adipose tissue is alike, and that health risk is associated with the location as well as the amount of body fat. Different depots are sufficiently distinct with respect to fatty-acid storage and release as to probably play unique roles in human physiology. Whether fat redistribution causes metabolic disease or whether it is a marker of underlying processes that are primarily responsible is an open question. CONTENT: The limited expandability of the subcutaneous adipose tissue leads to inappropriate adipose cell expansion (hypertrophic obesity with local inflammation and a dysregulated and insulin-resistant adipose tissue. The inability to store excess fat in the subcutaneous adipose tissue is a likely key mechanism for promoting ectopic fat accumulation in tissues and areas where fat can be stored, including the intra-abdominal and visceral areas, in the liver, epi/pericardial area, around vessels, in the myocardium, and in the skeletal muscles. Many studies have implicated ectopic fat accumulation and the associated lipotoxicity as the major determinant of the metabolic complications of obesity driving systemic insulin resistance, inflammation, hepatic glucose production, and dyslipidemia. SUMMARY: In summary, hypertrophic obesity is due to an impaired ability to recruit and differentiate available adipose precursor cells in the subcutaneous adipose tissue. Thus, the subcutaneous adipose tissue may be particular in its limited ability in certain individuals to undergo adipogenesis during weight increase. Inability to promote subcutaneous adipogenesis under periods of affluence would favor lipid overlow and ectopic fat accumulation with negative metabolic consequences. KEYWORDS: obesity, adipogenesis, subcutaneous adipose tissue, visceral adipose tissue, adipocyte dysfunction.

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

    Directory of Open Access Journals (Sweden)

    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

  2. The Relationship of Educational Attainment with Pulmonary Emphysema and Airway Wall Thickness.

    Science.gov (United States)

    Gjerdevik, Miriam; Grydeland, Thomas B; Washko, George R; Coxson, Harvey O; Silverman, Edwin K; Gulsvik, Amund; Bakke, Per S

    2015-06-01

    Low educational attainment is a risk factor of chronic obstructive pulmonary disease (COPD). There is limited knowledge on the relationship between educational level and computed tomography measures of emphysema and airway wall thickness (AWT). We hypothesized that low educational attainment is associated with increased emphysema and AWT in ever-smokers with and without COPD. We included 462 and 485 ever-smokers with and without COPD in a cross-sectional study, aged 40-86 years. The sample was divided into groups reflecting educational attainment: primary, secondary, and university. We performed linear regression to examine associations between educational attainment and both emphysema and AWT separately for those with and without COPD. We adjusted for sex, age, smoking status, age of onset of smoking, pack-years, height, and body mass index. Compared with university education, in subjects with COPD, primary education was associated with a 68.1% (95% confidence interval = 14.2-147.6%; P = 0.01) relative increase in emphysema and secondary education was associated with a 50.6% (95% confidence interval = 5.7-114.6%; P = 0.02) relative increase. There was a nonsignificant trend toward an association between lower educational attainment and increased emphysema among those without COPD (P = 0.18), yet greater age appeared to modify this association (P = 0.01). We did not detect significant linear relationships between educational attainment and AWT in subjects with or without COPD. Lower educational attainment was associated with increased emphysema among adults with COPD. Among those without COPD, this association was more pronounced with increasing age. No significant linear relationship between educational attainment and AWT was found. Clinicians treating adults with emphysema should keep in mind that factors related to low education beyond that of smoking and occupational dust exposure might be of importance to the disease.

  3. Resolvin D1 prevents smoking-induced emphysema and promotes lung tissue regeneration.

    Science.gov (United States)

    Kim, Kang-Hyun; Park, Tai Sun; Kim, You-Sun; Lee, Jae Seung; Oh, Yeon-Mok; Lee, Sang-Do; Lee, Sei Won

    2016-01-01

    Emphysema is an irreversible disease that is characterized by destruction of lung tissue as a result of inflammation caused by smoking. Resolvin D1 (RvD1), derived from docosahexaenoic acid, is a novel lipid that resolves inflammation. The present study tested whether RvD1 prevents smoking-induced emphysema and promotes lung tissue regeneration. C57BL/6 mice, 8 weeks of age, were randomly divided into four groups: control, RvD1 only, smoking only, and smoking with RvD1 administration. Four different protocols were used to induce emphysema and administer RvD1: mice were exposed to smoking for 4 weeks with poly(I:C) or to smoking only for 24 weeks, and RvD1 was injected within the smoking exposure period to prevent regeneration or after completion of smoking exposure to assess regeneration. The mean linear intercept and inflammation scores were measured in the lung tissue, and inflammatory cells and cytokines were measured in the bronchoalveolar lavage fluid. Measurements of mean linear intercept showed that RvD1 significantly attenuated smoking-induced lung destruction in all emphysema models. RvD1 also reduced smoking-induced inflammatory cell infiltration, which causes the structural derangements observed in emphysema. In the 4-week prevention model, RvD1 reduced the smoking-induced increase in eosinophils and interleukin-6 in the bronchoalveolar lavage fluid. In the 24-week prevention model, RvD1 also reduced the increased neutrophils and total cell counts induced by smoking. RvD1 attenuated smoking-induced emphysema in vivo by reducing inflammation and promoting tissue regeneration. This result suggests that RvD1 may be useful in the prevention and treatment of emphysema.

  4. Subcutaneous peritoneal access device for type I diabetic patients nonresponsive to subcutaneous insulin.

    Science.gov (United States)

    Schade, D S; Eaton, R P; Warhol, R M; Gregory, J A; Doberneck, R C

    1982-05-01

    Three type I diabetic patients nonresponsive to subcutaneous insulin were implanted with a subcutaneous peritoneal access device. In these patients, multiple subcutaneous injections had been unable to prevent recurrent hospital admissions for diabetic ketoacidosis. The patients were responsive to intravenous insulin but had limited accessible peripheral veins. Complications of thrombosis and/or septicemia from permanent central venous catheters prevented the long-term use of this route. The peritoneal access device was implanted subcutaneously adjacent to the umbilicus with its insulin delivery catheter terminating in the peritoneal space. Transcutaneous injection of insulin into the subcutaneous access port resulted in the same quantity of insulin entering the peritoneal space. Using a mixture of regular and protamine zinc insulin in a ration of 1:1 resulted in acute increases in plasma free insulin concentration with meals and a declining background level postprandially. All peritoneal access devices have been functioning well for at least 2 mo and in one of the implanted diabetic subjects, it has been in continuous use for 5 mo with no evidence of peritonitis or resistance to peritoneal insulin. These results suggest that a subcutaneous peritoneal access device may provide an alterative insulin delivery route for patients who are nonresponsive to subcutaneous insulin injections.

  5. Self-induced parapharyngeal and parotid emphysema: A case of pneumoparotitis

    Directory of Open Access Journals (Sweden)

    Javier González Lagunas

    2017-12-01

    Full Text Available Swelling of the parotid suggests pathological change. Enlargement of the parotid gland may result from infections, duct obstruction, benign or malignant tumors, allergies, autoimmune or systemic disease syndromes or lymphoproliferative diseases. Acute swelling is typically associated with viral infection or recurrent chronic parotitis. A rare cause of acute swelling is insufflation of air from the mouth via Stensen’s duct into the parotid region. We report a case of recurrent self-induced chronic pneumoparotitis with parapharyngeal extension in a teenager. Pneumoparotitis is rare and is often misdiagnosed and mistreated. Patients typically present with unilateral or bilateral painless swelling and tenderness in the parotid region. Imaging, including computer tomography scans, shows air within the parotid system that extends into the neighboring areas in cases of rupture of the parotid fascia. Salivary gland enlargement resolves spontaneously over 1–3 days. Some authors recommend anti-inflammatory drugs and prophylactic antibiotics to avoid superinfection. Several surgical treatments have been suggested for chronic and recurrent pneumoparotid. However, the primary challenge is to educate the patient to prevent an increase in intraoral pressure. Keywords: Pneumoparotitis, Pneumoparotiditis, Teenager, Head-and-neck emphysema

  6. Emphysematous gastritis and gastric emphysema: similar radiographic findings, distinct clinical entities.

    Science.gov (United States)

    Matsushima, Kazuhide; Won, Eugene J; Tangel, Matthew R; Enomoto, Laura M; Avella, Diego M; Soybel, David I

    2015-04-01

    Despite similar appearances on imaging studies, emphysematous gastritis (EG) and gastric emphysema (GE) are rare clinical entities encountered in surgical practices. The purpose of this review is to clarify the presentation, natural history, and optimal treatment strategies for these two disorders. We conducted a comprehensive literature review for reported adult cases of EG and GE in MEDLINE. Two cases from our institution were also included. Patient with demographics, diagnostic and therapeutic data, and outcomes were compared between patients with EG and GE. A total of 75 cases were included for our review. The finding of intramural air in the stomach was often associated with portal vein gas, pneumatosis intestinalis, or pneumoperitoneum in both groups. Surgical removal of the stomach was performed in 23.1% of EG patients, but only one patient in the GE group. In the EG group, overall mortality (55%) appeared to be driven by sepsis and its complications, whereas in the GE group, mortality (29%) was attributable to comorbid conditions and the underlying illness. Prompt surgical intervention is more commonly indicated for severe EG and is directed at removal of the septic organ, while the primary indication for surgical intervention in GE is the uncertainty of the diagnosis.

  7. Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter

    International Nuclear Information System (INIS)

    Rastogi, Shantanu; Gupta, Archana; Wung, Jen-Tien; Berdon, Walter E.

    2007-01-01

    Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure. We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes. A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000. The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO 2 levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax. The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications. (orig.)

  8. Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter

    Energy Technology Data Exchange (ETDEWEB)

    Rastogi, Shantanu [College of Physicians and Surgeons, Columbia University, Division of Neonatology, Department of Pediatrics, The Children' s Hospital of New York, New York, NY (United States); Maimonides Medical Center, Department of Pediatrics, Brooklyn, NY (United States); Gupta, Archana; Wung, Jen-Tien [College of Physicians and Surgeons, Columbia University, Division of Neonatology, Department of Pediatrics, The Children' s Hospital of New York, New York, NY (United States); Berdon, Walter E. [College of Physicians and Surgeons, Columbia University, Pediatric Radiology, The Children' s Hospital of New York, New York, NY (United States)

    2007-11-15

    Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure. We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes. A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000. The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO{sub 2} levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax. The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications. (orig.)

  9. Genome-wide study of percent emphysema on computed tomography in the general population. The Multi-Ethnic Study of Atherosclerosis Lung/SNP Health Association Resource Study

    NARCIS (Netherlands)

    Manichaikul, Ani; Hoffman, Eric A.; Smolonska, Joanna; Gao, Wei; Cho, Michael H.; Baumhauer, Heather; Budoff, Matthew; Austin, John H. M.; Washko, George R.; Carr, J. Jeffrey; Kaufman, Joel D.; Pottinger, Tess; Powell, Charles A.; Wijmenga, Cisca; Zanen, Pieter; Groen, Harry J.M.; Postma, Dirkje S.; Wanner, Adam; Rouhani, Farshid N.; Brantly, Mark L.; Powell, Rhea; Smith, Benjamin M.; Rabinowitz, Dan; Raffel, Leslie J.; Stukovsky, Karen D. Hinckley; Crapo, James D.; Beaty, Terri H.; Hokanson, John E.; Silverman, Edwin K.; Dupuis, Josee; O'Connor, George T.; Boezen, Hendrika; Rich, Stephen S.; Barr, R. Graham

    2014-01-01

    Rationale: Pulmonary emphysema overlaps partially with spirometrically defined chronic obstructive pulmonary disease and is heritable, with moderately high familial clustering. Objectives: To complete a genome-wide association study (GWAS) for the percentage of emphysema-like lung on computed

  10. An entirely subcutaneous implantable cardioverter-defibrillator

    NARCIS (Netherlands)

    G.H. Bardy (Gust); W.M. Smith (Warren); A.M. Hood (Margaret); I.G. Crozier (Ian); I.C. Melton (Iain Craig); L.J.L.M. Jordaens (Luc); D.A.M.J. Theuns (Dominic); E. Park (Robert); D.J. Wright (David Justin); D.T. Connelly (Derek); S.P. Fynn (Simon Patrick); F.D. Murgatroyd (Francis); J. Sperzel (Johannes); J. Neuzner (Jörg); S.G. Spitzer (Stefan); A.V. Ardashev (Andrey); A. Oduro (Amo); L. Boersma (Lucas); A.H. Maass (Alexander); I.C. van Gelder (Isabelle); A.A.M. Wilde (Arthur); P.F.H.M. van Pascal; R.E. Knops (Reinoud); C.S. Barr (Craig); P. Lupo (Pierpaolo); R. Cappato (Riccardo); A.A. Grace (Andrew)

    2010-01-01

    textabstractBACKGROUND: Implantable cardioverter-defibrillators (ICDs) prevent sudden death from cardiac causes in selected patients but require the use of transvenous lead systems. To eliminate the need for venous access, we designed and tested an entirely subcutaneous ICD system. METHODS: First,

  11. Transmissible Venereal Tumor with Subcutaneous and Bone ...

    African Journals Online (AJOL)

    A five year old entire mixed breed dog was admitted to the University of Nairobi's small animal clinic with a 5-months history of subcutaneous masses. Physical examination revealed firm and mobile masses in the subcuticular tissues, on the mandible and the transverse processes of the lumbar vertebrae. Visual inspection ...

  12. Subcutaneous endoscopically assisted ligation using miniport for ...

    African Journals Online (AJOL)

    Background This report describes the first miniport method using subcutaneous endoscopically assisted ligation (SEAL) for the treatment of girls with inguinal hernia. To validate its safety and efficacy, the authors evaluated their early experiences. Methods Between April 2014 and December 2014, 19 SEALs using miniport ...

  13. Anthropometrical Profile, Skinfold Tickness and Subcutaneous Fat ...

    African Journals Online (AJOL)

    Background: The threatening health problems resulting from excess subcutaneous fat depositions have been reported by the world Health Organization. Also noteworthy is that childhood obesity is a pointer to adult obesity. This necessitated a study on the anthropometrical profiles of adolescents of Southeast Nigeria using ...

  14. Retention of bacterial lipopolysaccharide at the site of subcutaneous injection.

    OpenAIRE

    Yokochi, T.; Inoue, Y.; Yokoo, J.; Kimura, Y.; Kato, N.

    1989-01-01

    The tissue distribution of Klebsiella pneumoniae O3 lipopolysaccharide (KO3 LPS) was studied in mice injected subcutaneously (s.c.) or intraperitoneally (i.p.) with 125I-labeled KO3 LPS. Marked retention of KO3 LPS radioactivity could be found at the site of s.c. injection for several weeks. On the other hand, about 85% of the radioactivity rapidly disappeared from the peritoneal cavity within 6 h after i.p. injection. The long-term presence of KO3 LPS at the injection site was also supported...

  15. Association of incidental emphysema with annual lung function decline and future development of airflow limitation

    Directory of Open Access Journals (Sweden)

    Koo HK

    2016-01-01

    Full Text Available Hyeon-Kyoung Koo,1 Kwang Nam Jin,2 Deog Kyeom Kim,3 Hee Soon Chung,3 Chang-Hoon Lee3,4 1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, College of Medicine, Ilsan Paik Hospital, Inje University, Goyang-si, Gyeonggi-Do, 2Department of Radiology, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, 3Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 4Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea Objectives: Emphysema is one of the prognostic factors for rapid lung function decline in patients with COPD, but the impact of incidentally detected emphysema on population without spirometric abnormalities has not been evaluated. This study aimed to determine whether emphysema detected upon computed tomography (CT screening would accelerate the rate of lung function decline and influence the possibility of future development of airflow limitation in a population without spirometric abnormalities.Materials and methods: Subjects who participated in a routine screening for health checkup and follow-up pulmonary function tests for at least 3 years between 2004 and 2010 were retrospectively enrolled. The percentage of low-attenuation area below −950 Hounsfield units (%LAA−950 was calculated automatically. A calculated value of %LAA−950 that exceeded 10% was defined as emphysema. Adjusted annual lung function decline was analyzed using random-slope, random-intercept mixed linear regression models.Results: A total of 628 healthy subjects within the normal range of spriometric values were included. Multivariable analysis showed that the emphysema group exhibited a faster decline in forced vital capacity (−33.9 versus −18.8

  16. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD.

    Science.gov (United States)

    Jones, Joshua H; Zelt, Joel T; Hirai, Daniel M; Diniz, Camilla V; Zaza, Aida; O'Donnell, Denis E; Neder, J Alberto

    2017-04-01

    There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV 1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO 2 output ([Formula: see text]CO 2 ) nadir. Pulmonary blood flow (PBF) in a submaximal test was calculated by inert gas rebreathing. Emphysema was quantified as % of attenuation areas below 950 HU. Patients typically presented with centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/total lung ratio = 0.82 ± 0.04). They had lower peak oxygen uptake ([Formula: see text]O 2 ), higher [Formula: see text]E/[Formula: see text]CO 2 nadir, and greater dyspnea scores than controls (p exercise (p exercise (r = -0.69) (p exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (D L CO) to a key clinical outcome (poor exercise tolerance) in COPD patients with only modest spirometric abnormalities.

  17. Impact of iterative reconstructions on objective and subjective emphysema assessment with computed tomography: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Steve P.; Gariani, Joanna; Hachulla, Anne-Lise; Botsikas, Diomidis; Becker, Christoph D.; Montet, Xavier [Geneva University Hospitals, Division of Radiology, Department of Imaging and Medical Information Sciences, Geneva (Switzerland); Adler, Dan [Geneva University Hospitals, Division of Pneumology, Department of Internal Medicine, Geneva (Switzerland); Karenovics, Wolfram [Geneva University Hospitals, Division of Thoracic Surgery, Department of Surgery, Geneva (Switzerland)

    2017-07-15

    To prospectively evaluate the impact of iterative reconstruction (IR) algorithms on pulmonary emphysema assessment as compared to filtered back projection (FBP). One hundred ten unenhanced chest CT examinations were obtained on two different scanners. Image reconstructions from a single acquisition were done with different levels of IR and compared with FBP on the basis of the emphysema index (EI), lung volume and voxel densities. Objective emphysema assessment was performed with 3D software provided by each manufacturer. Subjective assessment of emphysema was performed as a blinded evaluation. Quantitative and subjective values were compared using repeated ANOVA analysis, Bland-Altman analysis and Kendall's coefficient of concordance (W). Lung volumes are stable on both units, throughout all IR levels (P ≥ 0.057). EI significantly decreases on both units with the use of any level of IR (P < 0.001). The highest levels of IR are responsible for a decrease of 33-36 % of EI. Significant differences in minimal lung density are found between the different algorithms (P < 0.003). Intra- and inter-reader concordance for emphysema characterisation is generally good (W ≥ 0.77 and W ≥ 0.86, respectively). Both commercially available IR algorithms used in this study significantly changed EI but did not alter visual assessment compared to standard FBP reconstruction at identical radiation exposure. (orig.)

  18. Frequency of Epidermal Growth Factor Receptor Mutation in Smokers with Lung Cancer Without Pulmonary Emphysema.

    Science.gov (United States)

    Takeda, Kenichi; Yamasaki, Akira; Igishi, Tadashi; Kawasaki, Yuji; Ito-Nishii, Shizuka; Izumi, Hiroki; Sakamoto, Tomohiro; Touge, Hirokazu; Kodani, Masahiro; Makino, Haruhiko; Yanai, Masaaki; Tanaka, Natsumi; Matsumoto, Shingo; Araki, Kunio; Nakamura, Hiroshige; Shimizu, Eiji

    2017-02-01

    Chronic obstructive pulmonary disease is a smoking-related disease, and is categorized into the emphysema and airway dominant phenotypes. We examined the relationship between emphysematous changes and epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. The medical records for 250 patients with lung adenocarcinoma were retrospectively reviewed. All patients were categorized into the emphysema or non-emphysema group. Wild-type EGFR was detected in 136 (54%) and mutant EGFR in 48 (19%). Emphysematous changes were observed in 87 (36%) patients. EGFR mutation was highly frequent in the non-emphysema group (p=0.0014). Multivariate logistic regression analysis showed that emphysema was an independent risk factor for reduced frequency of EGFR mutation (Odds Ratio=3.47, p=0.005). Our data showed a relationship between emphysematous changes and EGFR mutation status. There might be mutually exclusive genetic risk factors for carcinogenesis and development of emphysematous changes. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  19. Nitric oxide diffusing capacity versus spirometry in the early diagnosis of emphysema in smokers.

    Science.gov (United States)

    van der Lee, I; Gietema, H A; Zanen, P; van Klaveren, R J; Prokop, M; Lammers, J-W J; van den Bosch, J M M

    2009-12-01

    The diffusion capacity for nitric oxide (DLNO) is independent of pulmonary capillary blood volume and equals the membrane diffusing capacity. Therefore the DLNO could be more sensitive in detecting alveolar destruction than the DLCO. We measured flow-volumes curves, DLNO, DLCO, the transfer coefficients KNO (DLNO/VA) and KCO (DLCO/VA) and performed computed tomography (CT) scans in 263 randomly selected heavy smokers. Subjects with areas > or =1% of the total lung volume showing an attenuation <-950 Hounsfield Units were considered to have emphysema. In 36 subjects emphysema was diagnosed with CT, a low KNO was present in 94 subjects, and in 95 subjects a FEV1/FVC ratio <70% was seen. The area under the ROC curve for detection CT-based emphysema was 0.894 for the KNO, 0.822 for the KCO and 0.795 for FEV1/FVC, meaning that the KNO has a slightly higher sensitivity to detect emphysema than the KCO and FEV1/FVC. The positive predictive value of KNO however was low (34.7%), while the negative predictive value of KNO was very high (98.2%), indicating an emphysema exclusion test. The DLNO/DLCO ratio is significantly higher in the study group compared to normal subjects.

  20. Detecting airway remodeling in COPD and emphysema using low-dose CT imaging

    Science.gov (United States)

    Rudyanto, R.; Ceresa, M.; Muñoz-Barrutia, A.; Ortiz-de-Solorzano, C.

    2012-03-01

    In this study, we quantitatively characterize lung airway remodeling caused by smoking-related emphysema and Chronic Obstructive Pulmonary Disease (COPD), in low-dose CT scans. To that end, we established three groups of individuals: subjects with COPD (n=35), subjects with emphysema (n=38) and healthy smokers (n=28). All individuals underwent a low-dose CT scan, and the images were analyzed as described next. First the lung airways were segmented using a fast marching method and labeled according to its generation. Along each airway segment, cross-section images were resampled orthogonal to the airway axis. Next 128 rays were cast from the center of the airway lumen in each crosssection slice. Finally, we used an integral-based method, to measure lumen radius, wall thickness, mean wall percentage and mean peak wall attenuation on every cast ray. Our analysis shows that both the mean global wall thickness and the lumen radius of the airways of both COPD and emphysema groups were significantly different from those of the healthy group. In addition, the wall thickness change starts at the 3rd airway generation in the COPD patients compared with emphysema patients, who display the first significant changes starting in the 2nd generation. In conclusion, it is shown that airway remodeling happens in individuals suffering from either COPD or emphysema, with some local difference between both groups, and that we are able to detect and accurately quantify this process using images of low-dose CT scans.

  1. Evaluation of micro-CT for emphysema assessment in mice: comparison with non-radiological techniques

    International Nuclear Information System (INIS)

    Artaechevarria, Xabier; Ceresa, Mario; Perez-Martin, Daniel; Ortiz-de-Solorzano, Carlos; Munoz-Barrutia, Arrate; Blanco, David; Biurrun, Gabriel de; Montuenga, Luis M.; Bastarrika, Gorka; Torres, Juan P. de; Zulueta, Javier J.

    2011-01-01

    To define the potential, limitations and synergies of micro-CT and other non-radiological techniques for the quantification of emphysema and related processes in mice, by performing a complete characterization of the elastase-induced emphysema model. Ninety A/J mice (45 treated and 45 controls) were studied at different time points using breath-hold gated micro-CT, functional test parameters, RT-PCR for RNA cytokine expression, Luminex technology for cytokine plasma concentration and histomorphometry. Both histomorphometry and micro-CT imaging reflect rapid initial emphysema progression followed by steady-state development at decreasing rates. Cytokine measurements reveal an acute inflammatory response within the first 24 h that disappears after the first week. Limited systemic effect was observed based on plasma cytokine concentration. Lung compliance decreases during the acute inflammation phase and increases afterwards. Histomorphometry is the most sensitive technique since it detects airspace enlargement before the other methods (1 h after treatment). Micro-CT correlates well with histology (r2 = 0.63) proving appropriate for longitudinal studies. Functional test parameters do not necessarily correlate with the extent of emphysema, as they can be influenced by acute inflammation. Finally, cytokine measurements correlate with the presence of inflammation in histology but not with emphysema. (orig.)

  2. Evaluation of micro-CT for emphysema assessment in mice: comparison with non-radiological techniques

    Energy Technology Data Exchange (ETDEWEB)

    Artaechevarria, Xabier; Ceresa, Mario; Perez-Martin, Daniel; Ortiz-de-Solorzano, Carlos; Munoz-Barrutia, Arrate [University of Navarra, Cancer Imaging Laboratory, Oncology Division, Center for Applied Medical Research, Pamplona (Spain); Blanco, David; Biurrun, Gabriel de; Montuenga, Luis M. [University of Navarra, Biomarkers Laboratory, Oncology Division, Center for Applied Medical Research, Pamplona (Spain); Bastarrika, Gorka [University of Navarra, Radiology, Clinica Universidad de Navarra, Pamplona (Spain); Torres, Juan P. de; Zulueta, Javier J. [University of Navarra, Pneumology, Clinica Universidad de Navarra, Pamplona (Spain)

    2011-05-15

    To define the potential, limitations and synergies of micro-CT and other non-radiological techniques for the quantification of emphysema and related processes in mice, by performing a complete characterization of the elastase-induced emphysema model. Ninety A/J mice (45 treated and 45 controls) were studied at different time points using breath-hold gated micro-CT, functional test parameters, RT-PCR for RNA cytokine expression, Luminex technology for cytokine plasma concentration and histomorphometry. Both histomorphometry and micro-CT imaging reflect rapid initial emphysema progression followed by steady-state development at decreasing rates. Cytokine measurements reveal an acute inflammatory response within the first 24 h that disappears after the first week. Limited systemic effect was observed based on plasma cytokine concentration. Lung compliance decreases during the acute inflammation phase and increases afterwards. Histomorphometry is the most sensitive technique since it detects airspace enlargement before the other methods (1 h after treatment). Micro-CT correlates well with histology (r2 = 0.63) proving appropriate for longitudinal studies. Functional test parameters do not necessarily correlate with the extent of emphysema, as they can be influenced by acute inflammation. Finally, cytokine measurements correlate with the presence of inflammation in histology but not with emphysema. (orig.)

  3. Chronic obstructive pulmonary disease severity is associated with severe pneumonia

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2015-01-01

    Full Text Available CONTEXT: Chronic obstructive pulmonary disease (COPD is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients. AIMS: We examined the risk factors associated with severe pneumonia in a COPD population. MATERIALS AND METHODS: We performed a retrospective observational study using a prospectively collected database of pneumonia patients who were admitted to our hospital through emergency department between 2008 and 2012. Patients with hospital-acquired pneumonia and those with an immunocompromised status were excluded. RESULTS: Of 148 pneumonia patients with COPD for whom chest computed tomography (CT scans were available, 106 (71.6% and 42 (28.4% were classified as non-severe and severe pneumonia, respectively. Multivariate logistic regression analysis revealed that the severity of airflow limitation [odds ratio (OR, 2.751; 95% confidence interval (CI, 1.074-7.050; P = 0.035] and the presence of emphysema on a chest CT scan (OR, 3.366; 95% CI, 1.104-10.265; P = 0.033 were independently associated with severe pneumonia in patients with COPD. CONCLUSIONS: The severity of COPD including the airflow limitation grade and the presence of pulmonary emphysema were independently associated with the development of severe pneumonia.

  4. Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?

    NARCIS (Netherlands)

    A.H. Kars (Alice); G. Goorden; Th. Stijnen (Theo); J.M. Bogaard (Jan); A.F.M. Verbraak (Anton); C. Hilvering

    1995-01-01

    textabstractIt has been postulated that serial inhomogeneity of ventilation in the peripheral airways in emphysema is represented by the shape of expiratory carbon dioxide tension versus volume curve. We examined the diagnostic value of this test in patients with various degrees of emphysema. The

  5. INVITRO RELEASE OF NEUTROPHIL ELASTASE, MYELOPEROXIDASE AND BETA-GLUCURONIDASE IN PATIENTS WITH EMPHYSEMA AND HEALTHY-SUBJECTS

    NARCIS (Netherlands)

    RENKEMA, TEJ; POSTMA, DS; NOORDHOEK, JA; SLUITER, HJ; KAUFFMAN, HF

    1991-01-01

    Evidence is accumulating that cigarette smoking plays an important role in the protease-antiprotease imbalance in alpha-1-antitrypsin-sufficient emphysema. Since most smokers, however, do not develop emphysema, it has to be presumed that other factors in addition to smoking contribute to the origin

  6. GLUCOSE-CONCENTRATION IN SUBCUTANEOUS EXTRACELLULAR-SPACE

    NARCIS (Netherlands)

    SCHMIDT, FJ; SLUITER, WJ; SCHOONEN, AJM

    OBJECTIVE- To compare the subcutaneous glucose sensor measurements with two reference methods. Previous studies provide conflicting findings about the real glucose concentrations in subcutaneous tissue. Some suggest substantially lower concentration, whereas others measure proportionally higher

  7. The value of cardiac catheterization and cineangiography in infantile lobar emphysema

    International Nuclear Information System (INIS)

    Roguin, N.; Peleg, H.; Naveh, Y.; Riss, E.; Technion-Israel Inst. of Tech., Haifa. Cardiothoraic Surgery; Technion-Israel Inst. of Tech., Haifa. Dept. of Pediatrics)

    1980-01-01

    Lobar emphysema is an uncommon cause of respiratory distress in infancy. Congenital heart disease is seen in about 20% of the patients with infantile (congenital) lobar emphysema. We described six infants with lobar emphysema. In three of them a congenital heart disease was demonstrated by cardiac catheterization and cineangiography; two had a tetralogy of Fallot with right aortic arch and the third infant a ventricular septal defect. The pulmonary angiography showed stretching of the arteries with very poor filling of the peripheral arteries and a characteristic smaller pulmonary vein in the affected lobe. In all the six patients the pulmonary artery pressure was normal. All the patients underwent lobectomy with good results. We feel that a preoperative cardiac catheterization and cineangiography is of value in this very sick group of infants. (orig.) [de

  8. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation

    International Nuclear Information System (INIS)

    Berk, David R.; Varich, Laura J.

    2005-01-01

    Localized persistent pulmonary interstitial emphysema has rarely been reported in preterm infants in the absence of utilization of mechanical ventilation or continuous positive airway pressure. The relative rarity of this condition might preclude rendering of the correct diagnosis, making patients susceptible to unnecessary surgery and increased morbidity and mortality associated with such intervention. We present a preterm infant who developed respiratory distress and radiographic findings of pulmonary interstitial emphysema on the first day after birth, prior to receiving continuous positive airway pressure or mechanical ventilation. It is important for radiologists to consider localized persistent pulmonary interstitial emphysema in the differential diagnosis of cystic lung lesions in preterm infants, even in the absence of mechanical ventilation. In cases where there is uncertainty, CT imaging can be useful in making the correct diagnosis. (orig.)

  9. Nitric oxide prevents alveolar senescence and emphysema in a mouse model.

    Directory of Open Access Journals (Sweden)

    Amanda E Boe

    Full Text Available Nω-nitro-L-arginine methyl ester (L-NAME treatment induces arteriosclerosis and vascular senescence. Here, we report that the systemic inhibition of nitric oxide (NO production by L-NAME causes pulmonary emphysema. L-NAME-treated lungs exhibited both the structural (alveolar tissue destruction and functional (increased compliance and reduced elastance characteristics of emphysema development. Furthermore, we found that L-NAME-induced emphysema could be attenuated through both genetic deficiency and pharmacological inhibition of plasminogen activator inhibitor-1 (PAI-1. Because PAI-1 is an important contributor to the development of senescence both in vitro and in vivo, we investigated whether L-NAME-induced senescence led to the observed emphysematous changes. We found that L-NAME treatment was associated with molecular and cellular evidence of premature senescence in mice, and that PAI-1 inhibition attenuated these increases. These findings indicate that NO serves to protect and defend lung tissue from physiological aging.

  10. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Berk, David R. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States); Varich, Laura J. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Stanford University School of Medicine, Department of Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2005-12-01

    Localized persistent pulmonary interstitial emphysema has rarely been reported in preterm infants in the absence of utilization of mechanical ventilation or continuous positive airway pressure. The relative rarity of this condition might preclude rendering of the correct diagnosis, making patients susceptible to unnecessary surgery and increased morbidity and mortality associated with such intervention. We present a preterm infant who developed respiratory distress and radiographic findings of pulmonary interstitial emphysema on the first day after birth, prior to receiving continuous positive airway pressure or mechanical ventilation. It is important for radiologists to consider localized persistent pulmonary interstitial emphysema in the differential diagnosis of cystic lung lesions in preterm infants, even in the absence of mechanical ventilation. In cases where there is uncertainty, CT imaging can be useful in making the correct diagnosis. (orig.)

  11. Low agreement of visual rating for detailed quantification of pulmonary emphysema in whole-lung CT.

    Science.gov (United States)

    Mascalchi, Mario; Diciotti, Stefano; Sverzellati, Nicola; Camiciottoli, Gianna; Ciccotosto, Cesareo; Falaschi, Fabio; Zompatori, Maurizio

    2012-02-01

    Multidetector spiral computed tomography (CT) has opened the possibility of quantitative evaluation of emphysema extent in the whole lung. Visual assessment can be used for such a purpose, but its reproducibility has not been established. To assess agreement of detailed assessment of pulmonary emphysema on whole-lung CT using a visual scale. Thirty patients with chronic obstructive pulmonary disease underwent whole-lung inspiratory CT. Four chest radiologists rated the same 22 ± 2 thin sections using a visual scale which defines a range of emphysema extent between 0 and 100. Two of them repeated the rating two months later. Inter- and intra-operator agreement was evaluated with the Bland and Altman method. In addition, the percentage of emphysema at -950 Hounsfield units in the whole lung was determined using fully automated commercially available software for 3D densitometry. In three of six operator pairs and in one of two intra-operator pairs the Kendall τ test showed a significant correlation between the difference and the average magnitude of visual scores. Among different operators the half-width of 95% limits of agreement (95% LoA) was wide ranging between a score of 14.2-27.7 for an average visual score of 20 and between 18.5-36.8 for an average visual score of 80. Within the same operator the half-width of 95% LoA ranged between a score of 10.9-21.0 for an average visual score of 20 and between 25.1-30.1 for an average visual score of 80. The visual scores of the four radiologists were correlated with the results of densitometry (P emphysema in the whole lung using a visual scale is low and decreases with increasing emphysema extent.

  12. Low agreement of visual rating for detailed quantification of pulmonary emphysema in whole-lung CT

    Energy Technology Data Exchange (ETDEWEB)

    Mascalchi, Mario; Diciotti, Stefano (Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence (Italy)), Email: m.mascalchi@dfc.unifi.it; Sverzellati, Nicola (Department of Radiology, University of Parma, Parma (Italy)); Camiciottoli, Gianna (Department of Critical Care, University of Florence, Florence (Italy)); Ciccotosto, Cesareo (Division of Radiology, Arezzo Hospital, Arezzo (Italy)); Falaschi, Fabio (Second Division of Radiology, Cisanello Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa (Italy)); Zompatori, Maurizio (Department of Radiology, S Orsola Hospital of Bologna, University of Bologna, Bologna (Italy))

    2012-02-15

    Background. Multidetector spiral computed tomography (CT) has opened the possibility of quantitative evaluation of emphysema extent in the whole lung. Visual assessment can be used for such a purpose, but its reproducibility has not been established. Purpose. To assess agreement of detailed assessment of pulmonary emphysema on whole-lung CT using a visual scale. Material and Methods. Thirty patients with chronic obstructive pulmonary disease underwent whole-lung inspiratory CT. Four chest radiologists rated the same 22 +- 2 thin sections using a visual scale which defines a range of emphysema extent between 0 and 100. Two of them repeated the rating two months later. Inter- and intra-operator agreement was evaluated with the Bland and Altman method. In addition, the percentage of emphysema at -950 Hounsfield units in the whole lung was determined using fully automated commercially available software for 3D densitometry. Results. In three of six operator pairs and in one of two intra-operator pairs the Kendall t test showed a significant correlation between the difference and the average magnitude of visual scores. Among different operators the half-width of 95% limits of agreement (95% LoA) was wide ranging between a score of 14.2-27.7 for an average visual score of 20 and between 18.5-36.8 for an average visual score of 80. Within the same operator the half-width of 95% LoA ranged between a score of 10.9-21.0 for an average visual score of 20 and between 25.1-30.1 for an average visual score of 80. The visual scores of the four radiologists were correlated with the results of densitometry (P < 0.001; r = 0.65-0.81). Conclusion. The inter- and intra-operator agreement of detailed assessment of emphysema in the whole lung using a visual scale is low and decreases with increasing emphysema extent

  13. Prevalence and characteristics of paratracheal air cysts and their association with emphysema in a general population

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Hua-Ming, E-mail: moyercheng@gmail.com [Department of Medical Imaging, Chi-Mei Medical Center, No. 901, Chung Hwa Road, Yong-Kang, Tainan 710, Taiwan (China); Chang, Pau-Yang, E-mail: pausheng@gmail.com [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China); Chiang, Kuo-Hsien, E-mail: moyer20361@yahoo.com.tw [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China); Huang, Hsin-Wen, E-mail: hwhuang660@gmail.com [Department of Diagnostic Radiology, Mennonite Christian Hospital, 44 Min-chuan Road, Hualien 970, Taiwan (China); Lee, Chau-Chin, E-mail: moyermiming@yahoo.com.tw [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China)

    2012-10-15

    Background: To evaluate the prevalence and characteristics of paratracheal air cysts and their association with emphysema and gender in a general population using low-dose computed tomography scanning of the chest. Materials and methods: We retrospectively enrolled a total of 924 patients (584 women, 340 men; mean age, 59.73 years; range, 37–89 years) who had received low-dose computed tomography scanning for health examination during the period January 1, 2010 to June 30, 2010. Computed tomographic images were evaluated for the presence of paratracheal air cysts. If paratracheal air cysts were identified, the lungs were reconstructed as a three-dimensional model on a commercial workstation. An emphysema index, an objective quantification of the extent of emphysematous changes on CT imaging, was defined as the percentage area of lung with attenuation values below −950 Hounsfield units. Results: A total of 60 patients with paratracheal air cysts were included in this study (estimated prevalence, 6.5%; 12 men, 48 women; mean age, 59.85; range 45–89 years). Emphysema index differed significantly between genders (P < 0.0001). The prevalence of paratracheal air cysts in men was significantly lower than that in women (P = 0.005); however, the emphysema index in patients of both genders showed no evidence of emphysema. The majority (95%) of paratracheal air cysts were at the level of the seventh cervical to the second thoracic vertebrae. Conclusion: The presence of paratracheal air cysts is a common condition in general populations and should not be misdiagnosed as abnormal paratracheal free air. Paratracheal air cysts are more common in woman than in man. In our study, there is no patient with paratracheal air cysts has CT evidence of emphysema.

  14. CT-derived Biomechanical Metrics Improve Agreement Between Spirometry and Emphysema.

    Science.gov (United States)

    Bhatt, Surya P; Bodduluri, Sandeep; Newell, John D; Hoffman, Eric A; Sieren, Jessica C; Han, Meilan K; Dransfield, Mark T; Reinhardt, Joseph M

    2016-10-01

    Many patients with chronic obstructive pulmonary disease (COPD) have marked discordance between forced expiratory volume in 1 second (FEV1) and degree of emphysema on computed tomography (CT). Biomechanical differences between these patients have not been studied. We aimed to identify reasons for the discordance between CT and spirometry in some patients with COPD. Subjects with Global initiative for chronic Obstructive Lung Disease stages I-IV from a large multicenter study (The Genetic Epidemiology of COPD) were arranged by percentiles of %predicted FEV1 and emphysema on CT. Three categories were created using differences in percentiles: Catspir with predominant airflow obstruction/minimal emphysema, CatCT with predominant emphysema/minimal airflow obstruction, and Catmatched with matched FEV1 and emphysema. Image registration was used to derive Jacobian determinants, a measure of lung elasticity, anisotropy, and strain tensors, to assess biomechanical differences between groups. Regression models were created with the previously mentioned categories as outcome variable, adjusting for demographics, scanner type, quantitative CT-derived emphysema, gas trapping, and airway thickness (model 1), and after adding biomechanical CT metrics (model 2). Jacobian determinants, anisotropy, and strain tensors were strongly associated with FEV1. With Catmatched as control, model 2 predicted Catspir and CatCT better than model 1 (Akaike information criterion 255.8 vs. 320.8). In addition to demographics, the strongest independent predictors of FEV1 were Jacobian mean (β = 1.60,95%confidence intervals [CI] = 1.16 to 1.98; P spirometry, offering the potential for new insights into the linkage between regional parenchymal destruction and global decrement in lung function in patients with COPD. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  15. Influence of radiological emphysema on lung function test in idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Bodlet, Aline; Maury, Gisèle; Jamart, Jacques; Dahlqvist, Caroline

    2013-11-01

    Idiopathic pulmonary fibrosis (IPF) is one of the most frequent interstitial lung disease. Emphysema can be associated with IPF as described in the «Combined pulmonary fibrosis and emphysema» syndrome. The primary endpoint of this retrospective cohort study was to evaluate the impact of the association of IPF and emphysema on lung function tests parameters (FVC, TLC, FEV1, FEV1/FVC and DLCO). The secondary endpoint was to assess the impact of the associated radiological emphysema on lung function parameters used in the du Bois prognostic score recently developed by Ron du Bois et al. We retrospectively reviewed the medical files of 98 patients with lung fibrosis who were followed in our University Hospital with access to pharmacological studies and lung transplantation from 1981 to 2011. Fifty six patients were considered for analysis. The collected data included gender, age, smoking history and respiratory hospitalizations. We also analysed their pulmonary functional parameters along with radiological characteristics, in particular the presence of emphysema which was assessed on thoracic high resolution CT scan. The du Bois score was retrospectively calculated from these data. TLC and FVC at diagnosis were significantly higher in the IPF-E group compared to the IPF group (respectively 86.6 ± 17.2% pv versus 72.0 ± 15.0% pv; p: 0.004 and 86.8 ± 18.4% pv versus 72.6 ± 20.6% pv; p: 0.020). The [Formula: see text] used in the calculation of the du Bois prognostic score was significantly higher in the IPF-E group. By cons, [Formula: see text] was not statistically different between the two groups. Radiological emphysema associated with IPF had an impact on pulmonary function tests. Despite this difference, the du Bois score was not statistically different between these two groups. Nevertheless, after one year of follow up, the patients with emphysema were in a subclass with a lower mortality rate than those without emphysema. Copyright © 2013 Elsevier

  16. The use of nebulized glutathione in the treatment of emphysema: a case report.

    Science.gov (United States)

    Lamson, D W; Brignall, M S

    2000-10-01

    We present the case of a 95-year-old man with an acute respiratory crisis secondary to emphysema and apparent bronchial infection. Treatment with nebulized glutathione led to a rapid resolution of the crisis, as well as a marked improvement in the chronic course of the disease. This treatment has been used since for a number of patients with emphysema. The safety and bioavailability of this method of delivery have been established in human studies. Preliminary results suggest efficacy for nebulized administration of glutathione in this patient population. We suggest this treatment can be considered an option for acute respiratory crises due to COPD.

  17. Is neutrophil elastase the missing link between emphysema and fibrosis? Evidence from two mouse models

    Directory of Open Access Journals (Sweden)

    Martorana Piero A

    2005-07-01

    Full Text Available Abstract Background The separation of emphysema from fibrosis is not as clear-cut as it was thought in early studies. These two pathologies may be present at the same time in human lungs and in mice either instilled with elastolytic enzymes or bleomycin or exposed to cigarette-smoke. According to a current view, emphysema originates from a protease/antiprotease imbalance, and a role for antiproteases has also been suggested in the modulation of the fibrotic process. In this study we investigate in experimental animal models of emphysema and fibrosis whether neutrophil elastase may constitute a pathogenic link between these two pathologies. Methods This study was done in two animal models in which emphysema and fibrosis were induced either by bleomycin (BLM or by chronic exposure to cigarette-smoke. In order to assess the protease-dependence of the BLM-induced lesion, a group mice was treated with 4-(2-aminoethyl-benzenesulfonyl fluoride hydrochloride, a serine proteinase inhibitor active toward neutrophil elastase. Lungs from each experimental group were used for the immunohistochemical assessment of transforming growth factor-β (TGF-β and transforming growth factor-α (TGF-α and for determination of the mean linear intercept as well as the percent volume densities of fibrosis and of emphysematous changes. Additionally, the lungs were also assessed for desmosine content and for the determination of elastase levels in the pulmonary interstitium by means of immunoelectron microscopy. Results We demonstrate that in BLM-treated mice (i the development of elastolytic emphysema precedes that of fibrosis; (ii significant amount of elastase in alveolar interstitium is associated with an increased expression of TGF-β and TGF-α; and finally, (iii emphysematous and fibrotic lesions can be significantly attenuated by using a protease inhibitor active against neutrophil elastase. Also, in a strain of mice that develop both emphysema and fibrosis after

  18. 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

  19. Subcutaneous versus subcutaneous and intraperitoneal local anaesthetic in the management of post appendicectomy pain

    International Nuclear Information System (INIS)

    Qureshi, K.Z.; Gondal, Z.I.; Raza, A.

    2014-01-01

    To compare the efficacy of subcutaneous only and combined subcutaneous and peritoneal infiltration of 0.5% bupivacaine during appendicectomy for the management of early post operative pain. Study Design: Randomized controlled study. Place and Duration of Study: Department of Surgery, CMH Kohat from 13th December 2007 to 20th December 2008. Patients and Methods: Sixty patients of a cute appendicitis, divided into two groups of 30 each, were included in the study. Group A was given 0.5% bupivacaine subcutaneously, whereas group B was given the anaesthetic subcutaneously as well as intraperitoneally during appendectomy. Results: In group A, 24 (80%) were VAS (visual analoguescoring) 3 (uncomfortable) and 6 (20%) were VAS 2 (mild pain) whereas in study group B, 11 (36.6%) were VAS 3, 19 (63.3%) were VAS 2 and 19 (63.3%) were VAS 2 during 1st 12 hrs postoperatively (p=0.001). In 12-24 hrs post operatively, 15 (50%) patients were VAS 3 in group A and same number was VAS 2 and in group B, only 3 (10%) were in VAS 3 and 27 (90%) were VAS 2 (p=0.001). Conclusion: A combination of subcutaneous and peritoneal infiltration with bupivacaine is superior in relieving post appendectomy pain so patients require less dosage of analgesics in early post operative period along with early mobilization. (author)

  20. Rosiglitazone attenuates the metalloprotease/anti-metalloprotease imbalance in emphysema induced by cigarette smoke: involvement of extracellular signal-regulated kinase and NFκB signaling

    Directory of Open Access Journals (Sweden)

    Hou G

    2015-04-01

    Full Text Available Gang Hou, Yan Yin, Dan Han, Qiu-yue Wang, Jian Kang Department of Respiratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China Objective: We investigated how rosiglitazone attenuated cigarette smoke (CS-induced emphysema in a rat model. In particular, we focused on its possible effects on the imbalance between metalloprotease (MMP and anti-MMP activity, mitogen-activated protein kinase (MAPK phosphorylation, and nuclear factor kappa-light-chain-enhancer of activated B cell (NFκB signaling pathway over-activation.Methods: A total of 36 Wistar rats were divided into three groups (n=12 each: animals were exposed to CS for 12 weeks in the absence (the CS group or presence of 30 mg/kg rosiglitazone (the rosiglitazone-CS [RCS] group; a control group was treated with the rosiglitazone vehicle only, without any CS exposure. Histopathology of lung tissue in all groups was evaluated to grade severity of the disease. Expression levels of peroxisome proliferator-activated receptor γ (PPARγ, MMP2, and MMP9 in lung tissue were determined and compared using Western blotting and immunohistochemistry. Activation of MAPKs, NFκB, and the nuclear factor of kappa light polypeptide gene enhancer in B-cell inhibitor, alpha (IκBα phosphorylation in lung tissue was examined by Western blotting.Results: Emphysema-related pathology, based on inter-alveolar wall distance and alveolar density, was less severe in the RCS group than in the CS group. Compared with the CS group, levels of PPARγ were higher in the RCS group, and levels of MMP2 and MMP9 proteins were lower in the RCS rats. Levels of activated MAPKs and NFκB were also lower, while the IκBαphosphorylation was increased in the lung tissue of RCS rats.Conclusion: Our findings suggest that oral administration of rosiglitazone attenuates the metalloprotease activity induced by CS, and the underlying mechanism might involve the activation of signaling pathways

  1. Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wille, Mathilde M.W.; Dirksen, Asger; Shaker, Saher B. [Gentofte Hospital, Department of Respiratory Medicine, Hellerup (Denmark); Thomsen, Laura H. [Hvidovre Hospital, Department of Respiratory Medicine, Hvidovre (Denmark); Petersen, Jens [University of Copenhagen, Department of Computer Science, DIKU, Koebenhavn Oe (Denmark); Bruijne, Marleen de [University of Copenhagen, Department of Computer Science, DIKU, Koebenhavn Oe (Denmark); Erasmus MC -University Medical Center Rotterdam, Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Rotterdam (Netherlands); Pedersen, Jesper H. [Copenhagen University Hospital, Department of Thoracic Surgery, Rigshospitalet, Koebenhavn Oe (Denmark)

    2016-02-15

    Screening for lung cancer should be limited to a high-risk-population, and abnormalities in low-dose computed tomography (CT) screening images may be relevant for predicting the risk of lung cancer. Our aims were to compare the occurrence of visually detected emphysema and interstitial abnormalities in subjects with and without lung cancer in a screening population of smokers. Low-dose chest CT examinations (baseline and latest possible) of 1990 participants from The Danish Lung Cancer Screening Trial were independently evaluated by two observers who scored emphysema and interstitial abnormalities. Emphysema (lung density) was also measured quantitatively. Emphysema was seen more frequently and its extent was greater among participants with lung cancer on baseline (odds ratio (OR), 1.8, p = 0.017 and p = 0.002) and late examinations (OR 2.6, p < 0.001 and p < 0.001). No significant difference was found using quantitative measurements. Interstitial abnormalities were more common findings among participants with lung cancer (OR 5.1, p < 0.001 and OR 4.5, p < 0.001).There was no association between presence of emphysema and presence of interstitial abnormalities (OR 0.75, p = 0.499). Even early signs of emphysema and interstitial abnormalities are associated with lung cancer. Quantitative measurements of emphysema - regardless of type - do not show the same association. (orig.)

  2. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers

    Energy Technology Data Exchange (ETDEWEB)

    Winkler Wille, Mathilde Marie; Thomsen, Laura H.; Dirksen, Asger; Shaker, Saher B. [Gentofte Hospital, Department of Respiratory Medicine, Hellerup (Denmark); Petersen, Jens [Copenhagen University, Department of Computer Science, Copenhagen (Denmark); Pedersen, Jesper Holst [Copenhagen University Hospital, Department of Thoracic Surgery, Rigshospitalet, Copenhagen (Denmark)

    2014-11-15

    To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort. Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed. Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p < 0.001) time-trends in both emphysema presence and grading were found (higher prevalence and grade of emphysema in late CT examinations). Significant progression in emphysema was seen in continuous smokers, but not in former smokers. Agreement on centrilobular emphysema subtype was substantial; agreement on paraseptal subtype, moderate. Agreement on panlobular and mixed subtypes was only fair. Agreement was fair regarding airway analysis. Interstitial abnormalities were infrequent in the cohort, and agreement on these was fair to moderate. A highly significant time-trend was found regarding interstitial abnormalities, which were more frequent in late examinations. Visual scoring of chest CT is able to characterise the presence, pattern, and progression of early emphysema. Continuous smokers progress; former smokers do not. (orig.)

  3. The effects of emphysema on airway disease: Correlations between multi-detector CT and pulmonary function tests in smokers

    Energy Technology Data Exchange (ETDEWEB)

    Yahaba, Misuzu, E-mail: mis_misuzu@yahoo.co.jp; Kawata, Naoko, E-mail: chumito_03@yahoo.co.jp; Iesato, Ken, E-mail: iesato_k@yahoo.co.jp; Matsuura, Yukiko, E-mail: matsuyuki_future@yahoo.co.jp; Sugiura, Toshihiko, E-mail: sugiura@js3.so-net.ne.jp; Kasai, Hajime, E-mail: daikasai6075@yahoo.co.jp; Sakurai, Yoriko, E-mail: yoliri@nifty.com; Terada, Jiro, E-mail: jirotera@chiba-u.jp; Sakao, Seiichiro, E-mail: sakao@faculty.chiba-u.jp; Tada, Yuji, E-mail: ytada@faculty.chiba-u.jp; Tanabe, Nobuhiro, E-mail: ntanabe@faculty.chiba-u.jp; Tatsumi, Koichiro, E-mail: tatsumi@faculty.chiba-u.jp

    2014-06-15

    Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation caused by emphysema and small airway narrowing. Quantitative evaluation of airway dimensions by multi-detector computed tomography (MDCT) has revealed a correlation between airway dimension and airflow limitation. However, the effect of emphysema on this correlation is unclear. Objective: The goal of this study was to determine whether emphysematous changes alter the relationships between airflow limitation and airway dimensions as measured by inspiratory and expiratory MDCT. Methods: Ninety-one subjects underwent inspiratory and expiratory MDCT. Images were evaluated for mean airway luminal area (Ai), wall area percentage (WA%) from the third to the fifth generation of three bronchi (B1, B5, B8) in the right lung, and low attenuation volume percent (LAV%). Correlations between each airway index and airflow limitation were determined for each patient and compared between patients with and without evidence of emphysema. Results: In patients without emphysema, Ai and WA% from both the inspiratory and expiratory scans were significantly correlated with FEV{sub 1.} No correlation was detected in patients with emphysema. In addition, emphysematous COPD patients with GOLD stage 1 or 2 disease had significantly lower changes in B8 Ai than non-emphysematous patients. Conclusions: A significant correlation exists between airway parameters and FEV{sub 1} in patients without emphysema. Emphysema may influence airway dimensions even in patients with mild to moderate COPD.

  4. Improved correlation between CT emphysema quantification and pulmonary function test by density correction of volumetric CT data based on air and aortic density

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Song Soo [Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine (Korea, Republic of); Seo, Joon Beom, E-mail: seojb@amc.seoul.kr [Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of); Kim, Namkug; Chae, Eun Jin [Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of); Lee, Young Kyung [Department of Radiology, Kyung Hee University Hospital at Gangdong (Korea, Republic of); Oh, Yeon Mok; Lee, Sang Do [Division of Pulmonology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of)

    2014-01-15

    Objectives: To determine the improvement of emphysema quantification with density correction and to determine the optimal site to use for air density correction on volumetric computed tomography (CT). Methods: Seventy-eight CT scans of COPD patients (GOLD II–IV, smoking history 39.2 ± 25.3 pack-years) were obtained from several single-vendor 16-MDCT scanners. After density measurement of aorta, tracheal- and external air, volumetric CT density correction was conducted (two reference values: air, −1000 HU/blood, +50 HU). Using in-house software, emphysema index (EI) and mean lung density (MLD) were calculated. Differences in air densities, MLD and EI prior to and after density correction were evaluated (paired t-test). Correlation between those parameters and FEV{sub 1} and FEV{sub 1}/FVC were compared (age- and sex adjusted partial correlation analysis). Results: Measured densities (HU) of tracheal- and external air differed significantly (−990 ± 14, −1016 ± 9, P < 0.001). MLD and EI on original CT data, after density correction using tracheal- and external air also differed significantly (MLD: −874.9 ± 27.6 vs. −882.3 ± 24.9 vs. −860.5 ± 26.6; EI: 16.8 ± 13.4 vs. 21.1 ± 14.5 vs. 9.7 ± 10.5, respectively, P < 0.001). The correlation coefficients between CT quantification indices and FEV{sub 1}, and FEV{sub 1}/FVC increased after density correction. The tracheal air correction showed better results than the external air correction. Conclusion: Density correction of volumetric CT data can improve correlations of emphysema quantification and PFT.

  5. Smokers with emphysema and small airway disease on computed tomography have lower bone density

    NARCIS (Netherlands)

    Pompe, Esther|info:eu-repo/dai/nl/413994848; de Jong, Pim A|info:eu-repo/dai/nl/287955672; van Rikxoort, Eva M; Gallardo Estrella, Leticia; de Jong, W.U.; Vliegenthart, Rozemarijn; Oudkerk, Matthijs; van der Aalst, Carlijn M; van Ginneken, Bram|info:eu-repo/dai/nl/216387809; Lammers, Jan-Willem J|info:eu-repo/dai/nl/071697624; Mohamed Hoesein, Firdaus Aa|info:eu-repo/dai/nl/341235512

    2016-01-01

    Osteoporosis is more common in patients with COPD and in smokers. The aim of this study was to assess whether measures of emphysema and airway disease on computed tomography (CT) were associated with lower bone density or vertebral fractures in smokers with and without COPD. For this purpose, we

  6. Recurrent spontaneous pneumothoraces and bullous emphysema. A novel mutation causing Birt-Hogg-Dube syndrome.

    Science.gov (United States)

    Burkett, Andrew; Coffey, Niamh; Tomiak, Eva; Voduc, Nha

    2016-01-01

    Birt-Hogg-Dube syndrome (BHDS) is a rare form of classically cystic lung disease that may present with spontaneous pneumothorax. The associated skin manifestations (fibrofolliculomas) are not always present. This article describes a case of spontaneous pneumothorax secondary to bullous emphysema in an otherwise healthy gentleman caused by a novel mutation in the folliculin (FLCN) gene.

  7. Detection of COPD, lung function decline and emphysema progression in heavy smokers

    NARCIS (Netherlands)

    Mohamed Hoesein, F.A.A.

    2012-01-01

    The work presented in this thesis has improved our insights in important determinants of lung function decline and emphysema progression in heavy smokers. Secondly, it improved our insight on the question which threshold of FEV1/FVC is most appropriate in diagnosing COPD. We showed in chapter 2 that

  8. Survival benefit of cardiopulmonary bypass support in bilateral lung transplantation for emphysema patients

    NARCIS (Netherlands)

    Hepkema, BG; Loef, BG; van der Bij, W; Verschuuren, EAM; Lems, SPM; Ebels, T

    2002-01-01

    Background. This study is designed to examine a possible association of cardiopulmonary bypass (CPB) support and outcome of lung transplantation in a well-balanced group of emphysema patients. Methods. We performed a retrospective analysis of 62 consecutive primary bilateral lung transplantations

  9. Lung sound intensity in patients with emphysema and in normal subjects at standardised airflows

    NARCIS (Netherlands)

    Schreur, H. J.; Sterk, P. J.; Vanderschoot, J.; van Klink, H. C.; van Vollenhoven, E.; Dijkman, J. H.

    1992-01-01

    A common auscultatory finding in pulmonary emphysema is a reduction of lung sounds. This might be due to a reduction in the generation of sounds due to the accompanying airflow limitation or to poor transmission of sounds due to destruction of parenchyma. Lung sound intensity was investigated in

  10. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    , CT scans were performed to determine emphysema (%LAA), airway wall thickness (AWT-Pi10), and lung mass. Muscle wasting based on FFMI was assessed by bioelectrical impedance. In both the men and women with COPD, FFMI was negatively associated with %LAA. FMI was positively associated with AWT-Pi10...

  11. 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.

  12. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    The objective of the present study was to determine the association between CT phenotypes-emphysema by low attenuation area and bronchitis by airway wall thickness-and body composition parameters in a large cohort of subjects with and without COPD. In 452 COPD subjects and 459 subjects without CO...

  13. Propolis reversed cigarette smoke-induced emphysema through macrophage alternative activation independent of Nrf2

    NARCIS (Netherlands)

    Barroso, Marina Valente; Cattani-Cavalieri, Isabella; de Brito-Gitirana, Lycia; Fautrel, Alain; Lagente, Vincent; Schmidt, Martina; Porto, Luís Cristóvão; Romana-Souza, Bruna; Valença, Samuel Santos; Lanzetti, Manuella

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is an incurable and progressive disease. Emphysema is the principal manifestation of COPD, and the main cause of this condition is cigarette smoke (CS). Natural products have shown antioxidant and anti-inflammatory properties that can prevent acute lung

  14. Congenital lobar emphysema: 30-year case series in two university hospitals

    Directory of Open Access Journals (Sweden)

    Daniele Cristina Cataneo

    2013-06-01

    Full Text Available OBJECTIVE: To review the cases of patients with congenital lobar emphysema (CLE submitted to surgical treatment at two university hospitals over a 30-year period. METHODS: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up. RESULTS: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years. All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those. No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months, and no late complications were observed. CONCLUSIONS: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.

  15. Idiopathic pulmonary fibrosis with coexisting emphysema : high-resolution CT and clinical correlation

    International Nuclear Information System (INIS)

    Kang, Eun Young; Kim, Kyeong Ah; Oh, Yu Whan; Shim, Jae Jeong; Kang, Kyung Ho

    1997-01-01

    To correlate high-resolution CT (HRCT) findings with smoking history and pulmonary function test (PFT) in patients with idiopathic pulmonary fibrosis (IPF) with or without coexisting emphsema. The study included 24 patients who had undergone HRCT and in whom IPF had been confirmed pathologically (n=7) and clinically (n=17). The patients included 19 men and 5 women aged between from 44 and 78(mean 59) years. HRCT findings were reviewed by two radiologists and assessed for the presence and extent of emphysema (CT emphysema score;CES) and honeycombing (CT honeycombing score;CHS). CES and CHS were retrospectively correlated with smoking status and pulmonary function test. Evidence of emphysema was seen on HRCT in 20 fo 24 patients with IPF (83%). CES was 14.3 and CHS was 18.1 in smokers with IPF, as compared with 1.8 and 6.7 in nonsmokers (p<0.01). Pulmonary function tests showed lower percent predicted FEVI (69.3%), FVC (64.7%), TLC (73.7%), and RV (77.3%), a lower percent predicted diffusing capacity of carbon monoxide (58.2%), and normal FEVI/FVC (99.1%). The pulmonary function test in smokers showed higher TLC and RV than in nonsmokers. Eight of nine patients whose CES was higher than their CHS, an seen on HRCT, were smokers and had a smoking history of 33.1 pack-years. Seven of 15 whose CHS was higher than their CES were smokers and had a smoking history of 16.8 pack-years. In patients with a higher CES than CHS pulmonary function test results showed normal TLC(85%) and RV(100.7%); this contrasted with decreased TLC(72%) and RV (68%) in patients whose CHS was higher than their CES. Emphysema is a frequently associated finding in patients with IPF, as seen on HRCT, and emphysema is more frequent and extensive in smokers with IPF than non-smokers. HRCT is useful for detecting emphysema in patients with IPF, and the extent of emphysema on HRCT correlates with the results of the pulmonary function test and smoking status

  16. Switching between intravenous and subcutaneous trastuzumab

    DEFF Research Database (Denmark)

    Gligorov, Joseph; Curigliano, Giuseppe; Müller, Volkmar

    2017-01-01

    AIM: To assess the safety and tolerability of switching between subcutaneous (SC) and intravenous (IV) trastuzumab in the PrefHer study (NCT01401166). PATIENTS AND METHODS: Patients with HER2-positive early breast cancer completed (neo)adjuvant chemotherapy and were randomised to receive four....... Rates of clinically important events, including grade ≥3 AEs, serious AEs, AEs leading to study drug discontinuation and cardiac AEs, were low and similar between treatment arms (safety signals for trastuzumab were observed. CONCLUSIONS: PrefHer revealed...... that switching from IV to SC trastuzumab (hand-held syringe or SID) or vice versa did not impact the known safety profile of trastuzumab....

  17. Subcutaneous myiasis caused by Dermatobia hominis.

    Science.gov (United States)

    Logar, J; Beović, B; Triller, C; Rakovec, S

    2001-01-01

    A case of subcutaneous myiasis caused by the larvae of the Dermatobia hominis fly is described, involving the ankle region of a 25-y-old man who had returned from Peru. After removal of 4 larvae from the affected sites, the lesions healed in 2 weeks without further treatment. Because of the increasing number of people travelling to tropical America, physicians in Slovenia will have to consider Dermatobia myiasis in the differential diagnosis of furuncular lesions in patients with a relevant travel history.

  18. Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis

    DEFF Research Database (Denmark)

    Wille, Mathilde M. W.; Thomsen, Laura H.; Petersen, Jens

    2016-01-01

    Objectives: Screening for lung cancer should be limited to a high-risk-population, and abnormalities in low-dose computed tomography (CT) screening images may be relevant for predicting the risk of lung cancer. Our aims were to compare the occurrence of visually detected emphysema and interstitial.......499). Conclusions: Even early signs of emphysema and interstitial abnormalities are associated with lung cancer. Quantitative measurements of emphysema—regardless of type—do not show the same association. Key Points: • Visually detected emphysema on CT is more frequent in individuals who develop lung cancer...

  19. Propolis reversed cigarette smoke-induced emphysema through macrophage alternative activation independent of Nrf2.

    Science.gov (United States)

    Barroso, Marina Valente; Cattani-Cavalieri, Isabella; de Brito-Gitirana, Lycia; Fautrel, Alain; Lagente, Vincent; Schmidt, Martina; Porto, Luís Cristóvão; Romana-Souza, Bruna; Valença, Samuel Santos; Lanzetti, Manuella

    2017-10-15

    Chronic obstructive pulmonary disease (COPD) is an incurable and progressive disease. Emphysema is the principal manifestation of COPD, and the main cause of this condition is cigarette smoke (CS). Natural products have shown antioxidant and anti-inflammatory properties that can prevent acute lung inflammation and emphysema, but there are few reports in the literature regarding therapeutic approaches to emphysema. We hypothesized that supplementation with natural extracts would repair lung damage in emphysema caused by CS exposure. Mice were exposed to 60days of CS and then treated or not with three different natural extracts (mate tea, grape and propolis) orally for additional 60days. Histological analysis revealed significant improvements in lung histoarchitecture, with recovery of alveolar spaces in all groups treated with natural extracts. Propolis was also able to recovery alveolar septa and elastic fibers. Propolis also increased MMP-2 and decreased MMP-12 expression, favoring the process of tissue repair. Additionally, propolis recruited leukocytes, including macrophages, without ROS release. These findings led us to investigate the profile of these macrophages, and we showed that propolis could promote macrophage alternative activation, thus increasing the number of arginase-positive cells and IL-10 levels and favoring an anti-inflammatory microenvironment. We further investigated the participation of Nrf2 in lung repair, but no Nrf2 translocation to the nucleus was observed in lung cells. Proteins and enzymes related to Nrf2 were not altered, other than NQO1, which seemed to be activated by propolis in a Nrf2-independent manner. Finally, propolis downregulated IGF1 expression. In conclusion, propolis promoted lung repair in a mouse emphysema model via macrophage polarization from M1 to M2 in parallel to the downregulation of IGF1 expression in a Nrf2-independent manner. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Characterization of a Mouse Model of Emphysema Induced by Multiple Instillations of Low-Dose Elastase

    Directory of Open Access Journals (Sweden)

    Milena V. Oliveira

    2016-10-01

    Full Text Available Many experimental models have been proposed to study the pathophysiological features of emphysema, as well as to search for new therapeutic approaches for acute or chronically injured lung parenchyma. We aimed to characterize an emphysema model induced by multiple instillations of elastase by tracking the changes in inflammation, remodeling, and cardiac function after each instillation. Forty-eight C57BL/6 mice were randomly assigned across 2 groups. Emphysema (ELA animals received 1, 2, 3, or 4 intratracheal instillations of pancreatic porcine elastase (PPE, 0.2 IU with a 1-week interval between them. Controls (C received saline following the same protocol. Before and after implementation of the protocol, animals underwent echocardiographic analysis. After the first instillation of PPE, the percentage of mononuclear cells in the lung parenchyma was increased compared to C (p = 0.0001. The second instillation resulted in hyperinflated alveoli, increased mean linear intercept, and reduced elastic fiber content in lung parenchyma compared to C (p=0.0197. Following the third instillation, neutrophils and collagen fiber content in alveolar septa and airways were increased, whereas static lung elastance was reduced compared to C (p=0.0094. After the fourth instillation, the percentage of M1 macrophages in lungs; levels of interleukin-1beta, keratinocyte-derived chemokine, hepatocyte growth factor, and vascular endothelial growth factor; and collagen fiber content in the pulmonary vessel wall were increased compared to C (p=0.0096. At this time point, pulmonary arterial hypertension was apparent, with increased diastolic right ventricular wall thickness. In conclusion, the initial phase of emphysema was characterized by lung inflammation with predominance of mononuclear cells, whereas at the late stage, impairment of pulmonary and cardiovascular functions was observed. This model enables analysis of therapies at different time points during controlled

  1. Effect of Elastase-induced Emphysema on the Force-generating Ability of the Diaphragm

    Science.gov (United States)

    Supinski, Gerald S.; Kelsen, Steven G.

    1982-01-01

    The effect of emphysema on the ability of the diaphragm to generate force was examined in costal diaphragm muscle strips from 10 Golden hamsters killed 18 mo after intratracheal injection of pancreatic elastase in a dose producing hyperinflation (mean total lung capacity [TLC] = 163% of control) and generalized panacinar emphysema. 13 saline-injected normal animals served as controls. The time course of isometric tension and the effect of alterations in muscle fiber and sarcomere length on the isometric tension (T) generated in response to tetanizing electrical stimuli (length-tension [L-T] relationship) were examined. Elastase administration caused an increase in diaphragm muscle thickness and reduction in the length of costal diaphragm muscle fibers measured in situ. Emphysema significantly increased the maximum tetanic tension as a result of hypertrophy. Maximal tension corrected for increases in muscle cross-sectional area (T/cm2), however, was the same in emphysematous (E) and control (C) animals. Emphysema also shifted the muscle fiber L-T curve of the diaphragm but not of a control muscle, the soleus, toward shorter lengths. In contrast to the effects of E on the diaphragm muscle fiber L-T curve, the sarcomere L-T curve was the same in E and C. Since the length at which tension was maximal correlated closely with sarcomere number (r = 0.94; P < 0.001) reduction in the number of sarcomeres in series in muscles from emphysematous animals appeared to explain the shift in the muscle fiber L-T curve. We conclude that in elastase-induced emphysema adaptive changes both in diaphragm cross-sectional area and sarcomere number augment the force-generating ability of the diaphragm. We speculate that changes in sarcomere number compensate for alterations in muscle fiber length resulting from chronic hyperinflation of the thorax, while diaphragmatic muscle hypertrophy represents a response to changes in respiratory load and/or diaphragm configuration (La

  2. Kinetics of subcutaneous NPH insulin in diabetics

    Energy Technology Data Exchange (ETDEWEB)

    Kolendorf, K.; Bojsen, J.

    1982-04-01

    Kinetics of subcutaneous NPH insulin were studied in newly diagnosed insulin-dependent diabetics. Using a biotelemetric technique with small Geiger-Mueller detectors applied to the skin surface, the disappearance of 125I-NPH insulin fron subcutis was monoexponential with a mean half-life of 6.6 +/- 3.3 (SD) hr. A model is presented to compare the disappearance rates of subcutaneous 125I-NPH insulin and the calculated plasma appearance insulin curve derived from the actual plasma insulin concentration measurements, assuming a one-compartment model and first-order kinetics. Areas under the absorption- and appearance-time curves calculated from external measurements and from plasma insulin concentrations were identical. There was a strong correlation between plasma concentrations and absorbed amounts of labeled insulin (r . 0.8782, P less than 0.001), as there was between the blood glucose-lowering effects and percent absorbed insulin per hour (r . 0.7659, P less than 0.001). Our results indicate that the disappearance rate of iodine-labeled insulin was a relevant biological expression of insulin absorption from subcutis and a reliable noninvasive method of quantitative determination of insulin concentration in blood.

  3. Subcutaneous and Sublingual Immunotherapy in Allergic Asthma in Children

    Directory of Open Access Journals (Sweden)

    Sophia Tsabouri

    2017-04-01

    Full Text Available This review presents up-to-date understanding of immunotherapy in the treatment of children with allergic asthma. The principal types of allergen immunotherapy (AIT are subcutaneous immunotherapy (SCIT and sublingual immunotherapy (SLIT. Both of them are indicated for patients with allergic rhinitis and/or asthma, who have evidence of clinically relevant allergen-specific IgE, and significant symptoms despite reasonable avoidance measures and/or maximal medical therapy. Studies have shown a significant decrease in asthma symptom scores and in the use of rescue medication, and a preventive effect on asthma onset. Although the safety profile of SLIT appears to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT is better and that SCIT has an earlier onset than SLIT in children with allergic asthma. Severe, not controlled asthma, and medical error were the most frequent causes of SCIT-induced adverse events.

  4. Side effects during subcutaneous immunotherapy in children with allergic diseases.

    Science.gov (United States)

    Tophof, Max A; Hermanns, Anne; Adelt, Thomas; Eberle, Peter; Gronke, Christine; Friedrichs, Frank; Knecht, Roland; Mönter, Ernst; Schöpfer, Helmut; Schwerk, Nicolaus; Steinbach, Jörg; Umpfenbach, Hans-Ulrich; Weißhaar, Christian; Wilmsmeyer, Brigitte; Bufe, Albrecht

    2017-12-16

    Allergen-specific immunotherapy is the only causal form of therapy for IgE-mediated allergic diseases. Subcutaneous immunotherapy (SCIT) is considered safe and well tolerated in adults, yet there is less evidence of safety in the pediatric population. A non-interventional prospective observing longitudinal study was carried out to determine the incidence of local and systemic side effects by SCIT, routinely performed in pediatric patients. A total of 581 pediatric patients were observed in 18 study centers between March 2012 and October 2014, recording 8640 treatments and 10 015 injections. A total of 54.6% of the patients experienced immediate local side effects at least once; delayed local side effects were seen in 56.1%. Immediate systemic adverse reactions occurred in 2.2% of patients; 7.4% experienced delayed systemic side effects. However, severe systemic side effects (grade III in the classification of Ring and Messmer) were seen in 0.03% of all treatments, all appearing within 30 minutes after the injections. No grade IV reactions were observed. In addition, many potential risk factors were investigated, yet only a few were found to be associated with the occurrence of side effects. Subcutaneous immunotherapy is a safe form of therapy in pediatric patients, with similar rates of local side effects compared to adult patients and low rates of severe systemic side effects. However, local and systemic reactions occurring later than 30 minutes after injection were observed more often than expected, which makes it essential to be attentive on behalf of pediatricians, patients, and parents. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  5. Emphysema Is Common in Lungs of Cystic Fibrosis Lung Transplantation Patients : A Histopathological and Computed Tomography Study

    NARCIS (Netherlands)

    Mets, Onno M.; Roothaan, Suzan M.; Bronsveld, Inez; Luijk, Bart; van de Graaf, Ed A.; Vink, Aryan; de Jong, Pim A.

    2015-01-01

    Background Lung disease in cystic fibrosis (CF) involves excessive inflammation, repetitive infections and development of bronchiectasis. Recently, literature on emphysema in CF has emerged, which might become an increasingly important disease component due to the increased life expectancy. The

  6. Surgical Emphysema: A Rare Complication of a Simple Surgical Dental Extraction Without the Use of an Air-Driven Rotor.

    Science.gov (United States)

    Gowans, Keegan; Patel, Muneer; Lewis, Khari

    2017-03-01

    Surgical emphysema is a rare complication of dental extractions, often associated with the use of high-speed air rotors. This report describes a case of extensive surgical emphysema following a simple surgical extraction of a LL6 under local anaesthetic. There was no use of air-driven handpieces during the procedure. The patient developed extensive surgical emphysema bi-laterally in both cervical neck and facial planes. After prophylactic antibiotics with careful monitoring in a secondary care setting, the patient made a full unremarkable recovery. Clinical relevance: Simple extraction of teeth is a procedure carried out daily by most general dental practitioners. However, the risk of surgical emphysema without the use of high-speed air rotors or instruments using pressurized air/water is not well known or documented.

  7. Percent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study

    Science.gov (United States)

    Oelsner, Elizabeth C; Carr, J Jeffrey; Enright, Paul L; Hoffman, Eric A; Folsom, Aaron R; Kawut, Steven M; Kronmal, Richard A; Lederer, David J; Lima, Joao AC; Lovasi, Gina S; Smith, Benjamin M; Shea, Steven J; Barr, R Graham

    2016-01-01

    Background Emphysema on computed tomography (CT) is a risk factor for all-cause mortality in persons with and without airflow obstruction; however, causes of death associated with emphysema remain uncertain, particularly in the general population. Aims To test associations between quantitatively-assessed emphysema on CT and cause-of-death in persons with and without a substantial smoking history. Methods The Multi-Ethnic Study of Atherosclerosis recruited 6814 participants, age 45–84 years and without clinical cardiovascular disease, in 2000–02. Percent emphysema was defined on cardiac CT as percent of lung voxels emphysema on CT was defined as percent emphysema above the upper limit of normal. Cause-of-death was classified by administrative codes. Proportional-hazards models were adjusted for age, race/ethnicity, gender, body mass index, smoking status, pack-years, coronary artery calcium, site, and education. Additional adjustment for lung function was made in a subset with spirometry from 2004–06. Results There were 1091 deaths over 12 years median follow-up. Emphysema on CT was strongly associated with increased mortality due to respiratory diseases (adjusted hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.68–5.15), particularly chronic lower respiratory diseases (adjusted HR 9.54, 95% CI 4.70–19.35), and lung cancer (adjusted HR 1.84, 95% CI 1.09–3.12), but not cardiovascular disease. Associations persisted among participants with fewer than 10 pack-years and those without physician-diagnosed respiratory disease, and were similar after adjustment for airflow measures and in persons without airflow limitation. Conclusions Quantitatively-assessed emphysema on CT is associated with greater respiratory disease and lung cancer mortality, even among persons without traditional risk factors. PMID:27048196

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

    OpenAIRE

    Strange, Charlie; Herth, Felix JF; Kovitz, Kevin L; McLennan, Geoffrey; Ernst, Armin; Goldin, Jonathan; Noppen, Marc; Criner, Gerard J; Sciurba, Frank C

    2007-01-01

    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 val...

  9. Fully automatic quantitative assessment of emphysema in computed tomography: comparison with pulmonary function testing and normal values

    Energy Technology Data Exchange (ETDEWEB)

    Heussel, C.P.; Hantusch, R.; Hartlieb, S. [University Hospital Heidelberg, Thoraxklinik Heidelberg, Heidelberg (Germany); University Hospital Heidelberg, Department of Interventional and Diagnostic Radiology, Thoraxklinik Heidelberg, Heidelberg (Germany); Herth, F.J.F.; Kappes, J.; Eberhardt, R. [University Hospital Heidelberg, Thoraxklinik Heidelberg, Heidelberg (Germany); Johannes Gutenberg University, Department of Pneumology and Critical Care Medicine, Heidelberg (Germany); Weinheimer, O. [Johannes Gutenberg University, Department of Interventional and Diagnostic Radiology, Mainz (Germany); Kauczor, H.U. [University Hospital Heidelberg, Department of Diagnostic Radiology, Heidelberg (Germany)

    2009-10-15

    Characterisation and quantification of emphysema are necessary for planning of local treatment and monitoring. Sensitive, easy to measure, and stable parameters have to be established and their relation to the well-known pulmonary function testing (PFT) has to be investigated. A retrospective analysis of 221 nonenhanced thin-section MDCT with a corresponding PFT was carried out, with a subgroup analysis in 102 COPD stage III+IV, 44 COPD stage 0, and 33 investigations into interstitial lung disease (ILD). The in-house YACTA software was used for automatic quantification of lung and emphysema volume [l], emphysema index, mean lung density (MLD [HU]) and 15{sup th} percentile [HU]. CT-derived lung volume is significantly smaller in ILD (3.8) and larger in COPD (7.2) than in controls (5.9, p<0.0001). Emphysema volume and index are significantly higher in COPD than in controls (3.2 vs. 0.5, p<0.0001, 45% vs. 8%, p<0.0001). MLD and 15{sup th} percentile are significantly smaller in COPD (-877/-985, p<0.0001) and significantly higher in ILD (-777, p<0.0006/-914, p<0.0001) than in controls (-829/-935). A relevant amount of COPD patients apparently do not suffer from emphysema, while controls who do not fulfil PFT criteria for COPD also demonstrate CT features of emphysema. Automatic quantification of thin-section CT delivers convincing parameters and ranges that are able to differentiate among emphysema, control and ILD. An emphysema index of lower 20%, MLD higher than -850, and 15{sup th} percentile lower than -950 might be regarded as normal (thin-section, nonenhanced, B40, YACTA). These ranges might be helpful in the judgement of individual measures. (orig.)

  10. Robust, standardized quantification of pulmonary emphysema in low dose CT exams.

    Science.gov (United States)

    Ceresa, Mario; Bastarrika, Gorka; de Torres, Juan P; Montuenga, Luis M; Zulueta, Javier J; Ortiz-de-Solorzano, Carlos; Muñoz-Barrutia, Arrate

    2011-11-01

    The aim of this study was to present and evaluate a fully automated system for emphysema quantification on low-dose computed tomographic images. The platform standardizes emphysema measurements against changes in the reconstruction algorithm and slice thickness. Emphysema was quantified in 149 patients using a fully automatic, in-house developed software (the Robust Automatic On-Line Pulmonary Helper). The accuracy of the system was evaluated against commercial software, and its reproducibility was assessed using pairs of volume-corrected images taken 1 year apart. Furthermore, to standardize quantifications, the effect of changing the reconstruction parameters was modeled using a nonlinear fit, and the inverse of the model function was then applied to the data. The association between quantifications and pulmonary function testing was also evaluated. The accuracy of the in-house software compared to that of commercial software was measured using Spearman's rank correlation coefficient, the mean difference, and the intrasubject variability. Agreement between the methods was studied using Bland-Altman plots. To assess the reproducibility of the method, intraclass correlation coefficients and Bland-Altman plots were used. The statistical significance of the differences between the standardized data and the reference data (soft-tissue reconstruction algorithm B40f; slice thickness, 1 mm) was assessed using a paired two-sample t test. The accuracy of the method, measured as intrasubject variability, was 3.86 mL for pulmonary volume, 0.01% for emphysema index, and 0.39 Hounsfield units for mean lung density. Reproducibility, assessed using the intraclass correlation coefficient, was >0.95 for all measurements. The standardization method applied to compensate for variations in the reconstruction algorithm and slice thickness increased the intraclass correlation coefficients from 0.87 to 0.97 and from 0.99 to 1.00, respectively. The correlation of the standardized

  11. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Yoshitake [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan); Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Abe, Takayuki [Keio University School of Medicine, Center for Clinical Research, Tokyo (Japan); Ogawa, Kenji [Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan)

    2013-08-15

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA{sub -950}) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA{sub -950}. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA{sub -950}. (orig.)

  12. Subcutaneous Immunoglobulins: A Promising Alternative for Immunomodulation?

    Science.gov (United States)

    Sanchez-Ramon, Silvia; Corbi, Angel L; Fidalgo, Agueda Garcia; Dominguez-Soto, Angeles

    2016-01-01

    Cumulative recent evidence from clinical trials, observational studies and case reports has shown that subcutaneous administration of immunoglobulin (SCIg) exerts similar immunomodulatory capacity than intravenous immunoglobulin (IVIg) in autoimmune neurological diseases. Besides the beneficial clinical effects, the profile of safety and autonomy for the patient is higher for SCIg, while it is cost-saving in terms of the health resources used. However, there are still very few approved indications for SCIg and a certain resistance to choose SCIg for other autoimmune conditions even despite patients' interests. Here we present an updated review of the known immunomodulatory mechanisms of action of Ig and the current hypothesis supporting the clinical and immunological advantages of SCIg over IVIg that derive from their specific pharmacokinetic features. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  13. [ANSYS simulation of subcutaneous pustule electrical characteristics].

    Science.gov (United States)

    Liu, Baohua; Wang, Xuan; Zhu, Honglian; Wang, Guoyong

    2011-12-01

    With the growing number of clinical surgery, post-operative surgical wound infection has become a very difficult clinical problem. In the treatments of it, non-invasive test of wound infection and healing status has a significance in clinical medicine practice. In this paper, beginning with the electrical properties of skin tissue structure and on the basis of the electromagnetism and the human anatomy, using the finite element analysis software, we applied safe voltage on the 3D skin model, performed the subcutaneous pustule simulation study and gained the relational curve between depth and radius of the pustule model. The simulation results suggested that the method we put forward could be feasible, and it could provide basis for non-invasive detection of wound healing and wound infection status.

  14. Eczematous dermatitis due to subcutaneous teriparatide injection.

    Science.gov (United States)

    Chu, Howard; Kim, Dae Suk

    2016-05-01

    Teriparatide, or recombinant human parathyroid hormone, is approved for the treatment of osteoporosis. Possible cutaneous adverse events of teriparatide are urticaria, injection site pain, swelling, bruising, and pruritus. However, there have been no reports of widespread eczematous reactions caused by teriparatide. A 47-year-old male was recently diagnosed with osteogenesis imperfecta and prior to teeth extractions, he was subcutaneously injected with teriparatide. The patient developed multiple pruritic erythematous papules and plaques on his abdomen, around the site of the injection. A skin biopsy was done, which showed mild spongiosis and superficial perivenular lymphocytic infiltration with a few eosinophils. Drug-related eczematous changes were most likely suspected and in addition to the discontinuation of the injection, topical steroid was prescribed, in which dramatic improvements were observed. We report the eczematous hypersensitivity reaction caused by teriparatide, which is an adverse reaction that has not been reported before.

  15. The nematode Diplotridena henryi (Nematoda : Diplotriaenoidea) as the possible cause of subcutaneous emphysema and respiratory insufficiency in a great tit (Parus major)

    Czech Academy of Sciences Publication Activity Database

    Literák, I.; Baruš, Vlastimil; Hauptmanová, K.; Halouzka, R.

    2003-01-01

    Roč. 40, č. 1 (2003), s. 23-25 ISSN 0440-6605 Institutional research plan: CEZ:AV0Z6093917 Keywords : Parus major * Nematoda * respiratory insufficiency Subject RIV: EG - Zoology Impact factor: 0.474, year: 2003

  16. Visceral to subcutaneous fat ratio predicts acuity of diverticulitis.

    Science.gov (United States)

    Docimo, Salvatore; Lee, Young; Chatani, Prav; Rogers, Ann M; Lacqua, Frank

    2017-07-01

    There is an association between obesity and more complicated diverticular disease. We hypothesize that this link may be due to an increased level of visceral fat rather than an elevated body mass index alone. Adipose tissue secretes inflammatory cytokines, and chronic inflammation may account for the link between obesity and a more severe presentation of diverticular disease. We have applied a quantitative measure of visceral fat content in a series of patients admitted with diverticulitis, comparing those who required emergent versus elective surgical procedures for diverticulitis. We performed a retrospective review of all adult patients who underwent emergent or elective surgery at our institution for diverticulitis from 2010 to 2014. Data were collected on demographics, comorbidities, operative findings, complications, and length of stay. Radiologic measurements of adiposity were obtained from preoperative CT scans. Visceral fat areas and subcutaneous fat areas were measured, and the V/S ratio was calculated. Thirty-four patients underwent emergent and 32 patients underwent elective surgery. The mean age was 66.3 years for the emergent and 57.11 for the elective group (p = 0.04178). The perinephric, visceral, subcutaneous fat, and V/S ratio for the emergent group were 1.71, 185.22, 338.22, and 0.56 and were 1.11, 127.18, 295.28, and 0.46 for the elective group. The difference between the V/S ratio for each group was significant (p = 0.0238). The emergent group had an average LOS of 16.11 days compared to 5.15 for the elective group (p = diverticulitis. Patients with higher V/S fat ratios were more likely to require emergency surgery and have more complications and a longer LOS.

  17. A murine model of elastase- and cigarette smoke-induced emphysema

    Directory of Open Access Journals (Sweden)

    Rubia Rodrigues

    Full Text Available ABSTRACT Objective: To describe a murine model of emphysema induced by a combination of exposure to cigarette smoke (CS and instillation of porcine pancreatic elastase (PPE. Methods: A total of 38 C57BL/6 mice were randomly divided into four groups: control (one intranasal instillation of 0.9% saline solution; PPE (two intranasal instillations of PPE; CS (CS exposure for 60 days; and CS + PPE (two intranasal instillations of PPE + CS exposure for 60 days. At the end of the experimental protocol, all animals were anesthetized and tracheostomized for calculation of respiratory mechanics parameters. Subsequently, all animals were euthanized and their lungs were removed for measurement of the mean linear intercept (Lm and determination of the numbers of cells that were immunoreactive to macrophage (MAC-2 antigen, matrix metalloproteinase (MMP-12, and glycosylated 91-kDa glycoprotein (gp91phox in the distal lung parenchyma and peribronchial region. Results: Although there were no differences among the four groups regarding the respiratory mechanics parameters assessed, there was an increase in the Lm in the CS + PPE group. The numbers of MAC-2-positive cells in the peribronchial region and distal lung parenchyma were higher in the CS + PPE group than in the other groups, as were the numbers of cells that were positive for MMP-12 and gp91phox, although only in the distal lung parenchyma. Conclusions: Our model of emphysema induced by a combination of PPE instillation and CS exposure results in a significant degree of parenchymal destruction in a shorter time frame than that employed in other models of CS-induced emphysema, reinforcing the importance of protease-antiprotease imbalance and oxidant-antioxidant imbalance in the pathogenesis of emphysema.

  18. Normalized emphysema scores on low dose CT: Validation as an imaging biomarker for mortality.

    Directory of Open Access Journals (Sweden)

    Leticia Gallardo-Estrella

    Full Text Available The purpose of this study is to develop a computed tomography (CT biomarker of emphysema that is robust across reconstruction settings, and evaluate its ability to predict mortality in patients at high risk for lung cancer. Data included baseline CT scans acquired between August 2002 and April 2004 from 1737 deceased subjects and 5740 surviving controls taken from the National Lung Screening Trial. Emphysema scores were computed in the original scans (origES and after applying resampling, normalization and bullae analysis (normES. We compared the prognostic value of normES versus origES for lung cancer and all-cause mortality by computing the area under the receiver operator characteristic curve (AUC and the net reclassification improvement (NRI for follow-up times of 1-7 years. normES was a better predictor of mortality than origES. The 95% confidence intervals for the differences in AUC values indicated a significant difference for all-cause mortality for 2 through 6 years of follow-up, and for lung cancer mortality for 1 through 7 years of follow-up. 95% confidence intervals in NRI values showed a statistically significant improvement in classification for all-cause mortality for 2 through 7 years of follow-up, and for lung cancer mortality for 3 through 7 years of follow-up. Contrary to conventional emphysema score, our normalized emphysema score is a good predictor of all-cause and lung cancer mortality in settings where multiple CT scanners and protocols are used.

  19. Deficient retinoid-driven angiogenesis may contribute to failure of adult human lung regeneration in emphysema.

    Science.gov (United States)

    Ng-Blichfeldt, John-Poul; Alçada, Joana; Montero, M Angeles; Dean, Charlotte H; Griesenbach, Uta; Griffiths, Mark J; Hind, Matthew

    2017-06-01

    Molecular pathways that regulate alveolar development and adult repair represent potential therapeutic targets for emphysema. Signalling via retinoic acid (RA), derived from vitamin A, is required for mammalian alveologenesis, and exogenous RA can induce alveolar regeneration in rodents. Little is known about RA signalling in the human lung and its potential role in lung disease. To examine regulation of human alveolar epithelial and endothelial repair by RA, and characterise RA signalling in human emphysema. The role of RA signalling in alveolar epithelial repair was investigated with a scratch assay using an alveolar cell line (A549) and primary human alveolar type 2 (AT2) cells from resected lung, and the role in angiogenesis using a tube formation assay with human lung microvascular endothelial cells (HLMVEC). Localisation of RA synthetic (RALDH-1) and degrading (cytochrome P450 subfamily 26 A1 (CYP26A1)) enzymes in human lung was determined by immunofluorescence. Regulation of RA pathway components was investigated in emphysematous and control human lung tissue by quantitative real-time PCR and Western analysis. RA stimulated HLMVEC angiogenesis in vitro; this was partially reproduced with a RAR-α agonist. RA induced mRNA expression of vascular endothelial growth factor A (VEGFA) and VEGFR2. RA did not modulate AT2 repair. CYP26A1 protein was identified in human lung microvasculature, whereas RALDH-1 partially co-localised with vimentin-positive fibroblasts. CYP26A1 mRNA and protein were increased in emphysema. RA regulates lung microvascular angiogenesis; the endothelium produces CYP26A1 which is increased in emphysema, possibly leading to reduced RA availability. These data highlight a role for RA in maintenance of the human pulmonary microvascular endothelium. 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/.

  20. Microfibril Associated Protein 4 (MFAP4) as a biomarker of emphysema

    DEFF Research Database (Denmark)

    Johansson, Sofie Lock; Roberts, Nassim Bazeghi; Schlosser, Anders

    hypothesized that circulating MFAP4 reflects elastin degradation and thereby emphysema in COPD patients. Methods Plasma levels of MFAP4 (pMFAP4) were determined by ELISA in 74 Danish COPD patients from the multicentre ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) study...... and Fat Free Mass Index respective (FFMI), showing a significant negative association between MFAP4 and BMI (β:-0.03, pemphysema...

  1. Proteinase-antiproteinase imbalance in the pathogenesis of Emphysema: The role of metalloproteinases in lung damage

    OpenAIRE

    Pardo, A.; Selman, M.

    1999-01-01

    Pulmonary emphysema refers to a lung disorder characterized by a diffuse destruction of the alveolar walls resulting in enlargement of the distal airspaces. The disease is usually a chronic, progressive, and disabling disorder. The concept of proteinaselantiproteinase imbalance evolved from the identification of patients with al-antytripsin deficiency, and from the development of experimental emphysematous lesions using different enzymes. For a long time, this ...

  2. Role of Liposuction Combined with Subcutaneous Mastectomy in ...

    African Journals Online (AJOL)

    were ruled out. Subcutaneous mastectomy using infraareolar skin incision combined with liposuction was performed on. 26 patients. ... Subcutaneous mastectomy is one of the common procedures performed with an infraareolar ... Mean age of the patients was 24 (±6) years; most of them were between 20 and 30 years old.

  3. Absorption Kinetics of Subcutaneously Administered Ceftazidime in Hypoperfused Guinea Pigs

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Ebihara, MS

    2015-12-01

    Conclusions: The application of MWCs or WCs enhanced subcutaneous CAZ absorption by increasing blood flow. MWCs and WCs are considered to be safe and routine methods to induce defecation after surgery on the digestive system; thus, the combination of these methods and subcutaneous CAZ administration is a potential method for treating pneumonia in patients with SMID.

  4. The comparison of the intestinal adaptation effects of subcutaneous ...

    African Journals Online (AJOL)

    Aim: Insulin has been reported to have positive effects on intestinal adaptation after short bowel syndrome when applicated oral or subcutaneously. The purpose of this study is to compare the intestinal adaptation effects of subcutaneous and oral routes of insulin in rats with short bowel syndrome. Materials and Methods: ...

  5. Cost-minimization of mabthera intravenous versus subcutaneous administration

    NARCIS (Netherlands)

    Bax, P.; Postma, M.J.

    2013-01-01

    Objectives: To identify and compare all costs related to preparing and administrating MabThera for the intravenous and subcutaneous formulations in Dutch hematological patients. The a priori notion is that the costs of subcutaneous MabThera injections are lower compared to intravenous infusion due

  6. Occurrence of ticks in the subcutaneous tissue of red foxes, Vulpes vulpes in Czech Republic and Romania.

    Science.gov (United States)

    D'Amico, G; Juránková, J; Tăbăran, F A; Frgelecová, L; Forejtek, P; Matei, I A; Ionică, A M; Hodžić, A; Modrý, D; Mihalca, A D

    2017-02-01

    An extensive survey of parasites in red foxes (Vulpes vulpes) was independently conducted in Romania and the Czech Republic. Carcasses were examined by necropsy, and small, dark nodules apparently containing ticks were noticed in the subcutaneous tissue of several foxes. Histopathological examination was performed using hematoxylin and eosin (HE) staining. Of the 91 foxes examined from the Czech Republic, 14 (15.4%) were harboring ticks in the subcutaneous tissue. In the majority of these cases, 1-3 nodules/fox were found, with a maximum of 31 nodules/fox. In Romania a single examined fox had subcutaneous ticks. All ticks collected from subcutaneous tissue were partially engorged adults. Based on morphological features, Ixodes ricinus, I. hexagonus, I. crenulatus and Dermacentor reticulatus were identified. The histopathological examination revealed chronic granulomatous panniculitis with peripheral fibrosis and intralesional presence of the ticks. Only few data are available regarding ticks localized in the subcutaneous tissue of any host. All the ticks were dead or already decomposed and it is evident that subcutaneous location does not represent an evolutionary advantage, as the detachment and finishing the life cycle is impossible. Copyright © 2016 Elsevier GmbH. All rights reserved.

  7. Editing out five Serpina1 paralogs to create a mouse model of genetic emphysema

    Science.gov (United States)

    Sun, Huaming; Zieger, Marina; Cox, Andrew; Cardozo, Brynn; Li, Weiying; Oliveira, Gabriella; Davis, Airiel; Gruntman, Alisha; Flotte, Terence R.; Brodsky, Michael H.; Hoffman, Andrew M.; Elmallah, Mai K.; Mueller, Christian

    2018-01-01

    Chronic obstructive pulmonary disease affects 10% of the worldwide population, and the leading genetic cause is α-1 antitrypsin (AAT) deficiency. Due to the complexity of the murine locus, which includes up to six Serpina1 paralogs, no genetic animal model of the disease has been successfully generated until now. Here we create a quintuple Serpina1a–e knockout using CRISPR/Cas9-mediated genome editing. The phenotype recapitulates the human disease phenotype, i.e., absence of hepatic and circulating AAT translates functionally to a reduced capacity to inhibit neutrophil elastase. With age, Serpina1 null mice develop emphysema spontaneously, which can be induced in younger mice by a lipopolysaccharide challenge. This mouse models not only AAT deficiency but also emphysema and is a relevant genetic model and not one based on developmental impairment of alveolarization or elastase administration. We anticipate that this unique model will be highly relevant not only to the preclinical development of therapeutics for AAT deficiency, but also to emphysema and smoking research. PMID:29453277

  8. Pathological and radiological correlation in an autopsy case of combined pulmonary fibrosis and emphysema

    Directory of Open Access Journals (Sweden)

    Karata H

    2015-07-01

    Full Text Available Hiroki Karata,1 Tomonori Tanaka,1 Ryoko Egashira,2 Kazuhiro Tabata,1 Kyoko Otani,3 Ryuji Hayashi,4 Takashi Hori,5 Junya Fukuoka1 1Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; 2Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan; 3Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan; 4Department of Internal Medicine, University of Toyama, Faculty of Medicine, Toyama, Japan; 5Laboratory of Pathology, Toyama University Hospital, Toyama, Japan Abstract: We report an educational autopsy case of combined pulmonary fibrosis and emphysema. Radiological patterns of the upper lung were considered as mostly emphysema, but pathological observation revealed significant interstitial fibrosis of usual interstitial pneumonia as a major pathology. The patient eventually developed acute exacerbation of background interstitial pneumonia. Careful radiological and pathological correlation of the current case indicates that regions with distal acinar emphysema on computed tomography image may possess histologically marked dense fibrosis of lethal interstitial pneumonia. Keywords: interstitial pneumonia, CPFE, AEF, smoking, CT

  9. Quantifying lung morphology with respiratory-gated micro-CT in a murine model of emphysema

    Science.gov (United States)

    Ford, N. L.; Martin, E. L.; Lewis, J. F.; Veldhuizen, R. A. W.; Holdsworth, D. W.; Drangova, M.

    2009-04-01

    Non-invasive micro-CT imaging techniques have been developed to investigate lung structure in free-breathing rodents. In this study, we investigate the utility of retrospectively respiratory-gated micro-CT imaging in an emphysema model to determine if anatomical changes could be observed in the image-derived quantitative analysis at two respiratory phases. The emphysema model chosen was a well-characterized, genetically altered model (TIMP-3 knockout mice) that exhibits a homogeneous phenotype. Micro-CT scans of the free-breathing, anaesthetized mice were obtained in 50 s and retrospectively respiratory sorted and reconstructed, providing 3D images representing peak inspiration and end expiration with 0.15 mm isotropic voxel spacing. Anatomical measurements included the volume and CT density of the lungs and the volume of the major airways, along with the diameters of the trachea, left bronchus and right bronchus. From these measurements, functional parameters such as functional residual capacity and tidal volume were calculated. Significant differences between the wild-type and TIMP-3 knockout groups were observed for measurements of CT density over the entire lung, indicating increased air content in the lungs of TIMP-3 knockout mice. These results demonstrate retrospective respiratory-gated micro-CT, providing images at multiple respiratory phases that can be analyzed quantitatively to investigate anatomical changes in murine models of emphysema.

  10. Normalizing computed tomography data reconstructed with different filter kernels: effect on emphysema quantification

    International Nuclear Information System (INIS)

    Gallardo-Estrella, Leticia; Prokop, Mathias; Lynch, David A.; Stinson, Douglas; Zach, Jordan; Judy, Philip F.; Ginneken, Bram van; Rikxoort, Eva M. van

    2016-01-01

    To propose and evaluate a method to reduce variability in emphysema quantification among different computed tomography (CT) reconstructions by normalizing CT data reconstructed with varying kernels. We included 369 subjects from the COPDGene study. For each subject, spirometry and a chest CT reconstructed with two kernels were obtained using two different scanners. Normalization was performed by frequency band decomposition with hierarchical unsharp masking to standardize the energy in each band to a reference value. Emphysema scores (ES), the percentage of lung voxels below -950 HU, were computed before and after normalization. Bland-Altman analysis and correlation between ES and spirometry before and after normalization were compared. Two mixed cohorts, containing data from all scanners and kernels, were created to simulate heterogeneous acquisition parameters. The average difference in ES between kernels decreased for the scans obtained with both scanners after normalization (7.7 ± 2.7 to 0.3 ± 0.7; 7.2 ± 3.8 to -0.1 ± 0.5). Correlation coefficients between ES and FEV 1 , and FEV 1 /FVC increased significantly for the mixed cohorts. Normalization of chest CT data reduces variation in emphysema quantification due to reconstruction filters and improves correlation between ES and spirometry. (orig.)

  11. Normalizing computed tomography data reconstructed with different filter kernels: effect on emphysema quantification

    Energy Technology Data Exchange (ETDEWEB)

    Gallardo-Estrella, Leticia; Prokop, Mathias [Radboud University Nijmegen Medical Center, Geert Grooteplein 10 (route 767), P.O. Box 9101, Nijmegen (766) (Netherlands); Lynch, David A.; Stinson, Douglas; Zach, Jordan [National Jewish Health, Denver, CO (United States); Judy, Philip F. [Brigham and Women' s Hospital, Boston, MA (United States); Ginneken, Bram van; Rikxoort, Eva M. van [Radboud University Nijmegen Medical Center, Geert Grooteplein 10 (route 767), P.O. Box 9101, Nijmegen (766) (Netherlands); Fraunhofer MEVIS, Bremen (Germany)

    2016-02-15

    To propose and evaluate a method to reduce variability in emphysema quantification among different computed tomography (CT) reconstructions by normalizing CT data reconstructed with varying kernels. We included 369 subjects from the COPDGene study. For each subject, spirometry and a chest CT reconstructed with two kernels were obtained using two different scanners. Normalization was performed by frequency band decomposition with hierarchical unsharp masking to standardize the energy in each band to a reference value. Emphysema scores (ES), the percentage of lung voxels below -950 HU, were computed before and after normalization. Bland-Altman analysis and correlation between ES and spirometry before and after normalization were compared. Two mixed cohorts, containing data from all scanners and kernels, were created to simulate heterogeneous acquisition parameters. The average difference in ES between kernels decreased for the scans obtained with both scanners after normalization (7.7 ± 2.7 to 0.3 ± 0.7; 7.2 ± 3.8 to -0.1 ± 0.5). Correlation coefficients between ES and FEV{sub 1}, and FEV{sub 1}/FVC increased significantly for the mixed cohorts. Normalization of chest CT data reduces variation in emphysema quantification due to reconstruction filters and improves correlation between ES and spirometry. (orig.)

  12. Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2015-01-01

    Full Text Available Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28% had grade IIA neuropathy, 20 (31% had grade IIB, and 27 (42% had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%, good in 16 (25%, fair in 7 (11%, and poor in 4 (6%, with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

  13. Identification of Primo-Vascular System in Abdominal Subcutaneous Tissue Layer of Rats

    Directory of Open Access Journals (Sweden)

    Chae Jeong Lim

    2015-01-01

    Full Text Available The primo-vascular system (PVS is a novel network identified in various animal tissues. However, the PVS in subcutaneous tissue has not been well identified. Here, we examined the putative PVS on the surface of abdominal subcutaneous tissue in rats. Hemacolor staining revealed dark blue threadlike structures consisting of nodes and vessels, which were frequently observed bundled with blood vessels. The structure was filled with various immune cells including mast cells and WBCs. In the structure, there were inner spaces (20–60 µm with low cellularity. Electron microscopy revealed a bundle structure and typical cytology common with the well-established organ surface PVS, which were different from those of the lymphatic vessel. Among several subcutaneous (sc PVS tissues identified on the rat abdominal space, the most outstanding was the scPVS aligned along the ventral midline. The distribution pattern of nodes and vessels in the scPVS closely resembled that of the conception vessel meridian and its acupoints. In conclusion, our results newly revealed that the PVS is present in the abdominal subcutaneous tissue layer and indicate that the scPVS tissues are closely correlated with acupuncture meridians. Our findings will help to characterize the PVS in the other superficial tissues and its physiological roles.

  14. Energy Harvesting by Subcutaneous Solar Cells: A Long-Term Study on Achievable Energy Output.

    Science.gov (United States)

    Bereuter, L; Williner, S; Pianezzi, F; Bissig, B; Buecheler, S; Burger, J; Vogel, R; Zurbuchen, A; Haeberlin, A

    2017-05-01

    Active electronic implants are powered by primary batteries, which induces the necessity of implant replacement after battery depletion. This causes repeated interventions in a patients' life, which bears the risk of complications and is costly. By using energy harvesting devices to power the implant, device replacements may be avoided and the device size may be reduced dramatically. Recently, several groups presented prototypes of implants powered by subcutaneous solar cells. However, data about the expected real-life power output of subcutaneously implanted solar cells was lacking so far. In this study, we report the first real-life validation data of energy harvesting by subcutaneous solar cells. Portable light measurement devices that feature solar cells (cell area = 3.6 cm 2 ) and continuously measure a subcutaneous solar cell's output power were built. The measurement devices were worn by volunteers in their daily routine in summer, autumn and winter. In addition to the measured output power, influences such as season, weather and human activity were analyzed. The obtained mean power over the whole study period was 67 µW (=19 µW cm -2 ), which is sufficient to power e.g. a cardiac pacemaker.

  15. EXPERIMENTAL SUBCUTANEOUS CYSTICERCOSIS BY Taenia crassiceps IN BALB/c AND C57BL/6 MICE

    Directory of Open Access Journals (Sweden)

    Íria Márcia PEREIRA

    2016-01-01

    Full Text Available SUMMARY Human cysticercosis is one of the most severe parasitic infections affecting tissues. Experimental models are needed to understand the host-parasite dynamics involved throughout the course of the infection. The subcutaneous experimental model is the closest to what is observed in human cysticercosis that does not affect the central nervous system. The aim of this study was to evaluate macroscopically and microscopically the experimental subcutaneous cysticercosis caused by Taenia crassiceps cysticerci in BALB/c and C57BL/6 mice. Animals were inoculated in the dorsal subcutaneous region and macroscopic and microscopic aspects of the inflammatory process in the host-parasite interface were evaluated until 90 days after the inoculation (DAI. All the infected animals presented vesicles containing cysticerci in the inoculation site, which was translucent at 7 DAI and then remained opaque throughout the experimental days. The microscopic analysis showed granulation tissue in BALB/c mice since the acute phase of infection evolving to chronicity without cure, presenting 80% of larval stage cysticerci at 90 DAI. While C57BL/6 mice presented 67% of final stage cysticerci at 90 DAI, the parasites were surrounded by neutrophils evolving to the infection control. It is possible to conclude that the genetic features of susceptibility (BALB/c or resistance (C57BL/6 were confirmed in an experimental subcutaneous model of cysticercosis.

  16. Smoking-related interstitial fibrosis combined with pulmonary emphysema: computed tomography-pathologic correlative study using lobectomy specimens

    Directory of Open Access Journals (Sweden)

    Otani H

    2016-07-01

    Full Text Available Hideji Otani,1 Tomonori Tanaka,2 Kiyoshi Murata,1 Junya Fukuoka,2 Norihisa Nitta,1 Yukihiro Nagatani,1 Akinaga Sonoda,1 Masashi Takahashi3 1Department of Radiology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 2Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, 3Department of Radiology, Yujin-Yamazaki Hospital, Takegahana-cho, Hikone, Shiga, Japan Purpose: To evaluate the incidence and pathologic correlation of thin-section computed tomography (TSCT findings in smoking-related interstitial fibrosis (SRIF with pulmonary emphysema. Patients and methods: Our study included 172 consecutive patients who underwent TSCT and subsequent lobectomy. TSCT findings including clustered cysts with visible walls (CCVW and ground-glass attenuation with/without reticulation (GGAR were evaluated and compared in nonsmokers and smokers and among lung locations. TSCT findings, especially CCVW, were also compared with histological findings using lobectomy specimens. Results: The incidence of CCVW and GGAR was significantly higher in smokers than in nonsmokers (34.1% and 40.7%, respectively, vs 2.0% and 12.2%. CCVW and GGAR were frequently found in the lower and peripheral zones. Histologically, CCVW corresponded more often with SRIF with emphysema than usual interstitial pneumonia (UIP, 63.3% vs 30%. CCVW of irregular size and shape were seen in 19 of 20 SRIF with emphysema and in seven of nine UIP-manifested areas with similar round cysts. A less-involved subpleural parenchyma was observed more frequently in SRIF with emphysema. Conclusion: SRIF with emphysema is a more frequent pathological finding than UIP in patients with CCVW on TSCT. The irregular size and shape of CCVW and a less-involved subpleural parenchyma may be a clue suggesting the presence of SRIF with emphysema. Keywords: pulmonary emphysema, smoking, usual interstitial pneumonia, honeycombing, smoking-related interstitial

  17. Iterative reconstruction for quantitative computed tomography analysis of emphysema: consistent results using different tube currents

    Directory of Open Access Journals (Sweden)

    Yamashiro T

    2015-02-01

    Full Text Available Tsuneo Yamashiro,1 Tetsuhiro Miyara,1 Osamu Honda,2 Noriyuki Tomiyama,2 Yoshiharu Ohno,3 Satoshi Noma,4 Sadayuki Murayama1 On behalf of the ACTIve Study Group 1Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan; 2Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 3Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; 4Department of Radiology, Tenri Hospital, Tenri, Nara, Japan Purpose: To assess the advantages of iterative reconstruction for quantitative computed tomography (CT analysis of pulmonary emphysema. Materials and methods: Twenty-two patients with pulmonary emphysema underwent chest CT imaging using identical scanners with three different tube currents: 240, 120, and 60 mA. Scan data were converted to CT images using Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR3D and a conventional filtered-back projection mode. Thus, six scans with and without AIDR3D were generated per patient. All other scanning and reconstruction settings were fixed. The percent low attenuation area (LAA%; < -950 Hounsfield units and the lung density 15th percentile were automatically measured using a commercial workstation. Comparisons of LAA% and 15th percentile results between scans with and without using AIDR3D were made by Wilcoxon signed-rank tests. Associations between body weight and measurement errors among these scans were evaluated by Spearman rank correlation analysis. Results: Overall, scan series without AIDR3D had higher LAA% and lower 15th percentile values than those with AIDR3D at each tube current (P<0.0001. For scan series without AIDR3D, lower tube currents resulted in higher LAA% values and lower 15th percentiles. The extent of emphysema was significantly different between each pair among scans when not using AIDR3D (LAA%, P<0.0001; 15th percentile, P<0.01, but was not

  18. Semi-automated scoring of pulmonary emphysema from X-ray CT: Trainee reproducibility and accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Owrangi, Amir M., E-mail: aowrangi@robarts.ca [Imaging Research Laboratories, Robarts Research Institute, London (Canada); Entwistle, Brandon, E-mail: Brandon.Entwistle@londonhospitals.ca; Lu, Andrew, E-mail: Andrew.Lu@londonhospitals.ca; Chiu, Jack, E-mail: Jack.Chiu@londonhospitals.ca; Hussain, Nabil, E-mail: Nabil.Hussain@londonhospitals.ca; Etemad-Rezai, Roya, E-mail: Roya.EtemadRezai@lhsc.on.ca; Parraga, Grace, E-mail: gparraga@robarts.ca [Imaging Research Laboratories, Robarts Research Institute, London (Canada); Graduate Program in Biomedical Engineering, Department of Medical Imaging, Department of Medical Biophysics, The University of Western Ontario, London (Canada)

    2013-11-01

    Objective: We developed a semi-automated tool to quantify emphysema from thoracic X-ray multi-detector (64-slice) computed tomography (CT) for training purposes and multi-reader studies. Materials and Methods: Thoracic X-ray CT was acquired in 93 ex-smokers, who were evaluated by six trainees with little or no expertise (trainees) and a single experienced thoracic radiologist (expert). A graphic user interface (GUI) was developed for emphysema quantification based on the percentile of lung where a score of 0 = no abnormalities, 1 = 1–25%, 2 = 26–50%, 3 = 51–75% and 4 = 76–100% for each lung side/slice. Trainees blinded to subject characteristics scored randomized images twice; accuracy was determined by comparison to expert scores, density histogram 15th percentile (HU{sub 15}), relative area at −950 HU (RA{sub 950}), low attenuation clusters at −950 HU (LAC{sub 950}), −856 HU (LAC{sub 856}) and the diffusing capacity for carbon monoxide (DL{sub CO%pred}). Intra- and inter-observer reproducibility was evaluated using coefficients-of-variation (COV), intra-class (ICC) and Pearson correlations. Results: Trainee–expert correlations were significant (r = 0.85–0.97, p < 0.0001) and a significant trainee bias (0.15 ± 0.22) was observed. Emphysema score was correlated with RA{sub 950} (r = 0.88, p < 0.0001), HU{sub 15} (r = −0.77, p < 0.0001), LAC{sub 950} (r = 0.76, p < 0.0001), LAC{sub 856} (r = 0.74, p = 0.0001) and DL{sub CO%pred} (r = −0.71, p < 0.0001). Intra-observer reproducibility (COV = 4–27%; ICC = 0.75–0.94) was moderate to high for trainees; intra- and inter-observer COV were negatively and non-linearly correlated with emphysema score. Conclusion: We developed a GUI for rapid and interactive emphysema scoring that allows for comparison of multiple readers with clinical and radiological standards.

  19. Sublingual or subcutaneous immunotherapy for allergic rhinitis?

    Science.gov (United States)

    Durham, Stephen R; Penagos, Martin

    2016-02-01

    Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  20. Classification of CT examinations for COPD visual severity analysis

    Science.gov (United States)

    Tan, Jun; Zheng, Bin; Wang, Xingwei; Pu, Jiantao; Gur, David; Sciurba, Frank C.; Leader, J. Ken

    2012-03-01

    In this study we present a computational method of CT examination classification into visual assessed emphysema severity. The visual severity categories ranged from 0 to 5 and were rated by an experienced radiologist. The six categories were none, trace, mild, moderate, severe and very severe. Lung segmentation was performed for every input image and all image features are extracted from the segmented lung only. We adopted a two-level feature representation method for the classification. Five gray level distribution statistics, six gray level co-occurrence matrix (GLCM), and eleven gray level run-length (GLRL) features were computed for each CT image depicted segment lung. Then we used wavelets decomposition to obtain the low- and high-frequency components of the input image, and again extract from the lung region six GLCM features and eleven GLRL features. Therefore our feature vector length is 56. The CT examinations were classified using the support vector machine (SVM) and k-nearest neighbors (KNN) and the traditional threshold (density mask) approach. The SVM classifier had the highest classification performance of all the methods with an overall sensitivity of 54.4% and a 69.6% sensitivity to discriminate "no" and "trace visually assessed emphysema. We believe this work may lead to an automated, objective method to categorically classify emphysema severity on CT exam.

  1. Energy Harvesting by Subcutaneous Solar Cells: A Long-Term Study on Achievable Energy Output

    OpenAIRE

    Bereuter, L.; Williner, S.; Pianezzi, F.; Bissig, B.; Buecheler, S.; Burger, J.; Vogel, R.; Zurbuchen, A.; Haeberlin, A.

    2017-01-01

    Active electronic implants are powered by primary batteries, which induces the necessity of implant replacement after battery depletion. This causes repeated interventions in a patients’ life, which bears the risk of complications and is costly. By using energy harvesting devices to power the implant, device replacements may be avoided and the device size may be reduced dramatically. Recently, several groups presented prototypes of implants powered by subcutaneous sola...

  2. Subcutaneous blood flow during insulin-induced hypoglycaemia

    DEFF Research Database (Denmark)

    Hilsted, J; Madsbad, S; Sestoft, L

    1982-01-01

    Subcutaneous blood flow was measured preceding insulin-induced hypoglycaemia, at the onset of hypoglycaemic symptoms and 2 h later in juvenile diabetics with and without autonomic neuropathy and in normal males. In all groups subcutaneous blood flow decreased at the onset of hypoglycaemic symptoms...... compared with pre-hypoglycaemic flow. Two hours after onset of hypoglycaemic symptoms, subcutaneous blood flow was still significantly decreased compared with pre-hypoglycaemic flow. In normal subjects local nerve blockade had no effect on blood flow changes during hypoglycaemia, whereas local alpha...

  3. Subcutaneous Zygomycosis : Current Indian Scenario With A Review

    Directory of Open Access Journals (Sweden)

    Thappa Devinder Mohan

    2003-01-01

    Full Text Available Zygomycosis broadly consists of mucormycosis and subcutaneous zygomycosis. Subcutaneous zygomycosis can further be subdivided into conidiobolomycosis and basidiobolomycosis. We have done retrospective analysis of data of cases of subcutaneous zygomycosis (basidiobolomycosis, diagnosis based on clinical features, histopathology and/or culture. The cases were treated in Dermatology and STD department of Jawaharlal Institute of postgraduate Medical Education and Research (JIPMER, Pondicherry between 1990 to 2002. Case reported in India has been summarized and relevant literature on this entity has been reviewed.

  4. Subcutaneous versus intravenous immunoglobulin in multifocal motor neuropathy

    DEFF Research Database (Denmark)

    Harbo, T; Andersen, Henning; Hess, A

    2009-01-01

    Background and purpose: For treatment of multifocal motor neuropathy (MMN), we hypothesized that (i) infusion of equivalent dosages of subcutaneous immunoglobulin (SCIG) is as effective as intravenous immunoglobulin (IVIG) and that (ii) subcutaneous infusion at home is associated with a better...... at the injection sites for a few weeks. All other adverse effects during SCIG were mild and transient. No differences between treatments of health-related quality of life occurred. Conclusion: In MMN, short-term subcutaneous infusion of immunoglobulin is feasible, safe and as effective as intravenous infusion...

  5. Subcutaneous phaeohyphomycosis due to Pyrenochaeta romeroi mimicking a synovial cyst

    Directory of Open Access Journals (Sweden)

    Aurelien Dinh

    2016-08-01

    Full Text Available Opportunistic subcutaneous fungal infections are increasing nowadays due to the growing number of medical conditions causing immunosuppression, especially organ transplant. The incidence rate of subcutaneous phaeohyphomycosis is very low. Most studies found are case reports. They showed a wide variation of clinical presentations. Pyrenochaeta romeroi, a fungus from the Dematiaceae group is a saprophyte found in soil and plants and a possible causative agent of phaeohyphomycosis. We present a rare case of subcutaneous phaeohyphomycosis caused by P. romeroi mimicking a synovial cyst in a diabetic patient.

  6. A treatment with a protease inhibitor recombinant from the cattle tick (Rhipicephalus Boophilus microplus ameliorates emphysema in mice.

    Directory of Open Access Journals (Sweden)

    Juliana D Lourenço

    Full Text Available AIMS: To determine whether a serine protease inhibitor treatment can prevent or minimize emphysema in mice. METHODS: C57BL/6 mice were subjected to porcine pancreatic elastase (PPE nasal instillation to induce emphysema and were treated with a serine protease inhibitor (rBmTI-A before (Protocol 1 and after (Protocol 2 emphysema development. In both protocols, we evaluated lung function to evaluate the airway resistance (Raw, tissue damping (Gtis and tissue elastance (Htis. The inflammatory profile was analyzed in the bronchoalveolar lavage (BALF and through the use of morphometry; we measured the mean linear intercept (Lm (to verify alveolar enlargement, the volume proportion of collagen and elastic fibers, and the numbers of macrophages and metalloprotease 12 (MMP-12 positive cells in the parenchyma. We showed that at both time points, even after the emphysema was established, the rBmTI-A treatment was sufficient to reverse the loss of elastic recoil measured by Htis, the alveolar enlargement and the increase in the total number of cells in the BALF, with a primary decrease in the number of macrophages. Although, the treatment did not control the increase in macrophages in the lung parenchyma, it was sufficient to decrease the number of positive cells for MMP-12 and reduce the volume of collagen fibers, which was increased in PPE groups. These findings attest to the importance of MMP-12 in PPE-induced emphysema and suggest that this metalloprotease could be an effective therapeutic target.

  7. Alveolar epithelial and endothelial cell apoptosis in emphysema: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Mathieu C Morissette

    2008-12-01

    Full Text Available Mathieu C Morissette, Julie Parent, Julie MilotCentre de Recherche de l’Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l’Université Laval, Québec, CanadaAbstract: Emphysema is mainly caused by cigarette smoking and is characterized by the loss of alveolar integrity and an enlargement of the alveolar space. However, mechanisms involved in its development are not fully understood. Alveolar cell apoptosis has been previously investigated in the lung of emphysematous subjects as a potential contributor to the loss of alveolar cell and has been found abnormally elevated. Though, mechanisms involved in the increased alveolar apoptosis that occurs in emphysema have now become a prolific field of research. Those mechanisms are reviewed here with special focus on how they affect cell viability and how they may be implicated in emphysema. Moreover, we suggest a model that integrates all those mechanisms to explain the increased alveolar apoptosis observed in emphysema. This review also includes some reflections and suggestions on the research to come.Keywords: emphysema, apoptosis, proteases, VEGF, oxidative stress, TRAIL, autoimmunity

  8. Longitudinal follow-up study of smoking-induced emphysema progression in low-dose CT screening of lung cancer

    Science.gov (United States)

    Suzuki, H.; Matsuhiro, M.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, Masahiro; Moriyama, N.

    2014-03-01

    Chronic obstructive pulmonary disease is a major public health problem that is predicted to be third leading cause of death in 2030. Although spirometry is traditionally used to quantify emphysema progression, it is difficult to detect the loss of pulmonary function by emphysema in early stage, and to assess the susceptibility to smoking. This study presents quantification method of smoking-induced emphysema progression based on annual changes of low attenuation volume (LAV) by each lung lobe acquired from low-dose CT images in lung cancer screening. The method consists of three steps. First, lung lobes are segmented using extracted interlobar fissures by enhancement filter based on fourdimensional curvature. Second, LAV of each lung lobe is segmented. Finally, smoking-induced emphysema progression is assessed by statistical analysis of the annual changes represented by linear regression of LAV percentage in each lung lobe. This method was applied to 140 participants in lung cancer CT screening for six years. The results showed that LAV progressions of nonsmokers, past smokers, and current smokers are different in terms of pack-year and smoking cessation duration. This study demonstrates effectiveness in diagnosis and prognosis of early emphysema in lung cancer CT screening.

  9. Visual classification of emphysema heterogeneity compared with objective measurements: HRCT vs spiral CT in candidates for lung volume reduction surgery

    International Nuclear Information System (INIS)

    Cederlund, K.; Hoegberg, S.; Rasmussen, E.; Svane, B.; Bergstrand, L.; Tylen, U.; Aspelin, P.

    2002-01-01

    The aim of this study was to investigate whether spiral CT is superior to high-resolution computed tomography (HRCT) in evaluating the radiological morphology of emphysema, and whether the combination of both CT techniques improves the evaluation in patients undergoing lung volume reduction surgery (LVRS). The material consisted of HRCT (with 2-mm slice thickness) and spiral CT (with 10-mm slice thickness) of 94 candidates for LVRS. Selected image pairs from these examinations were evaluated. Each image pair consisted of one image from the cranial part of the lung and one image from the caudal part. The degree of emphysema in the two images was calculated by computer. The difference between the images determined the degree of heterogeneity. Five classes of heterogeneity were defined. The study was performed by visual classification of 95 image pairs (spiral CT) and 95 image pairs (HRCT) into one of five different classes of emphysema heterogeneity. This visual classification was compared with the computer-based classification. Spiral CT was superior to HRCT with 47% correct classifications of emphysema heterogeneity compared with 40% for HRCT-based classification (p<0.05). The combination of the techniques did not improve the evaluation (42%). Spiral CT is superior to HRCT in determining heterogeneity of emphysema visually, and should be included in the pre-operative CT evaluation of LVRS candidates. (orig.)

  10. Visual classification of emphysema heterogeneity compared with objective measurements: HRCT vs spiral CT in candidates for lung volume reduction surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cederlund, K.; Hoegberg, S.; Rasmussen, E.; Svane, B. [Department of Thoracic Radiology, Karolinska Hospital, Stockholm (Sweden); Bergstrand, L. [Department of Radiology, Danderyds Hospital, Danderyd (Sweden); Tylen, U. [Deparment of Radiology, Sahlgrenska University Hospital, Gothenberg (Sweden); Aspelin, P. [Department of Radiology, Huddinge University Hospital, Huddinge (Sweden)

    2002-05-01

    The aim of this study was to investigate whether spiral CT is superior to high-resolution computed tomography (HRCT) in evaluating the radiological morphology of emphysema, and whether the combination of both CT techniques improves the evaluation in patients undergoing lung volume reduction surgery (LVRS). The material consisted of HRCT (with 2-mm slice thickness) and spiral CT (with 10-mm slice thickness) of 94 candidates for LVRS. Selected image pairs from these examinations were evaluated. Each image pair consisted of one image from the cranial part of the lung and one image from the caudal part. The degree of emphysema in the two images was calculated by computer. The difference between the images determined the degree of heterogeneity. Five classes of heterogeneity were defined. The study was performed by visual classification of 95 image pairs (spiral CT) and 95 image pairs (HRCT) into one of five different classes of emphysema heterogeneity. This visual classification was compared with the computer-based classification. Spiral CT was superior to HRCT with 47% correct classifications of emphysema heterogeneity compared with 40% for HRCT-based classification (p<0.05). The combination of the techniques did not improve the evaluation (42%). Spiral CT is superior to HRCT in determining heterogeneity of emphysema visually, and should be included in the pre-operative CT evaluation of LVRS candidates. (orig.)

  11. IL-17A is essential to the development of elastase-induced pulmonary inflammation and emphysema in mice

    Directory of Open Access Journals (Sweden)

    Kurimoto Etsuko

    2013-01-01

    Full Text Available Abstract Background Pulmonary emphysema is characterized by alveolar destruction and persistent inflammation of the airways. Although IL-17A contributes to many chronic inflammatory diseases, it’s role in the inflammatory response of elastase-induced emphysema remains unclear. Methods In a model of elastase-induced pulmonary emphysema we examined the response of IL-17A-deficient mice, monitoring airway inflammation, static compliance, lung histology and levels of neutrophil-related chemokine and pro-inflammatory cytokines in bronchoalveolar lavage (BAL fluid. Results Wild-type mice developed emphysematous changes in the lung tissue on day 21 after elastase treatment, whereas emphysematous changes were decreased in IL-17A-deficient mice compared to wild-type mice. Neutrophilia in BAL fluid, seen in elastase-treated wild-type mice, was reduced in elastase-treated IL-17A-deficient mice on day 4, associated with decreased levels of KC, MIP-2 and IL-1 beta. Elastase-treated wild-type mice showed increased IL-17A levels as well as increased numbers of IL-17A+ CD4 T cells in the lung in the initial period following elastase treatment. Conclusions These data identify the important contribution of IL-17A in the development of elastase-induced pulmonary inflammation and emphysema. Targeting IL-17A in emphysema may be a potential therapeutic strategy for delaying disease progression.

  12. The CT appearances of delayed amniotic fluid clearance from the lungs in an infant with absent pulmonary valve and congenital lobar emphysema

    International Nuclear Information System (INIS)

    Fink, A. Michelle; Edis, Brian; Massie, John

    2005-01-01

    Congenital lobar emphysema (CLE) is a cause of severe neonatal respiratory distress. Overexpansion of the affected pulmonary lobe in the fetus is due to narrowing of the airway, with a resultant 'ball-valve' effect. At birth, there may be delayed clearance of fetal lung fluid. Early chest radiographs show opacification of the hyperexpanded lobe. The CT findings in the immediate neonatal period have not been previously reported. We describe the imaging in a neonate with tetralogy of Fallot and absent pulmonary valve with secondary CLE. CT demonstrates the hyperexpanded lobe with initial thickening of the interlobular septa and alveolar ground glass attenuation, with subsequent clearing. This resorption of fetal lung fluid via the pulmonary interstitium should not be confused with interstitial lung disease. (orig.)

  13. The CT appearances of delayed amniotic fluid clearance from the lungs in an infant with absent pulmonary valve and congenital lobar emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Fink, A. Michelle [Royal Children' s Hospital, Department of Medical Imaging, Parkville, Victoria (Australia); University of Melbourne, Melbourne, Victoria (Australia); Edis, Brian [Royal Children' s Hospital, Department of Cardiology, Parkville, Victoria (Australia); Massie, John [University of Melbourne, Melbourne, Victoria (Australia); Royal Children' s Hospital, Department of Respiratory Medicine, Parkville, Victoria (Australia); Murdoch Children' s Research Institute, Melbourne, Victoria (Australia)

    2005-09-01

    Congenital lobar emphysema (CLE) is a cause of severe neonatal respiratory distress. Overexpansion of the affected pulmonary lobe in the fetus is due to narrowing of the airway, with a resultant 'ball-valve' effect. At birth, there may be delayed clearance of fetal lung fluid. Early chest radiographs show opacification of the hyperexpanded lobe. The CT findings in the immediate neonatal period have not been previously reported. We describe the imaging in a neonate with tetralogy of Fallot and absent pulmonary valve with secondary CLE. CT demonstrates the hyperexpanded lobe with initial thickening of the interlobular septa and alveolar ground glass attenuation, with subsequent clearing. This resorption of fetal lung fluid via the pulmonary interstitium should not be confused with interstitial lung disease. (orig.)

  14. 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.

  15. Smokers with CT detected emphysema and no airway obstruction have decreased plasma levels of EGF, IL-15, IL-8 and IL-1ra.

    Directory of Open Access Journals (Sweden)

    Juan P de-Torres

    Full Text Available RATIONALE: Low-grade inflammation and emphysema have been shown to be associated with an increased risk of lung cancer. However, the systemic inflammatory response in patients with emphysema is still unknown. OBJECTIVE: TO COMPARE THE PLASMA CYTOKINE PROFILES IN TWO GROUPS OF CURRENT OR FORMER SMOKERS WITHOUT AIRWAY OBSTRUCTION: a control group of individuals without computed tomography (CT detected emphysema vs. a study group of individuals with CT detected emphysema. METHODS: Subjects underwent a chest CT, spirometry, and determination of EGF, IL-15, IL-1ra, IL-8, MCP-1, MIP-1β, TGFα, TNFα, and VEGF levels in plasma. Cytokine levels in each group were compared adjusting for confounding factors. RESULTS: 160 current smokers and former smokers without airway obstruction participated in the study: 80 without emphysema and 80 subjects with emphysema. Adjusted group comparisons revealed significant reductions in EGF (-0.317, p = 0.01, IL-15 (-0.21, p = 0.01, IL-8 (-0.180, p = 0.02 and IL-1ra (-0.220, p = 0.03 in subjects with emphysema and normal spirometry. CONCLUSIONS: Current or former smokers expressing a well-defined disease characteristic such as emphysema, has a specific plasma cytokine profile. This includes a decrease of cytokines mainly implicated in activation of apoptosis or decrease of immunosurveillance. This information should be taken into account when evaluated patients with tobacco respiratory diseases.

  16. Subcutaneous blood flow during insulin-induced hypoglycaemia

    DEFF Research Database (Denmark)

    Hilsted, J; Madsbad, S; Sestoft, L

    1982-01-01

    Subcutaneous blood flow was measured preceding insulin-induced hypoglycaemia, at the onset of hypoglycaemic symptoms and 2 h later in juvenile diabetics with and without autonomic neuropathy and in normal males. In all groups subcutaneous blood flow decreased at the onset of hypoglycaemic symptoms...... compared with pre-hypoglycaemic flow. Two hours after onset of hypoglycaemic symptoms, subcutaneous blood flow was still significantly decreased compared with pre-hypoglycaemic flow. In normal subjects local nerve blockade had no effect on blood flow changes during hypoglycaemia, whereas local alpha......-receptor blockade abolished the vasoconstrictor response. We suggest that circulating catecholamines stimulating vascular alpha-receptors are probably responsible for flow reduction in the subcutaneous tissue during hypoglycaemia....

  17. Chordoma with postoperative subcutaneous implantation and meningeal dissemination: MRI

    International Nuclear Information System (INIS)

    Kinoshita, T.; Okudera, T.; Shimosegawa, E.; Hatazawa, J.; Yoshida, Y.; Yasui, N.; Ogawa, T.

    2001-01-01

    Chordomas are histologically benign tumours which are locally invasive. We present an unusual case of recurrent chordoma with subcutaneous implantation and widespread meningeal dissemination after surgery. Contrast-enhanced MRI was useful for determining the extent of the tumour. (orig.)

  18. Comparative Study of Efficacy and Safety of Botulinum Toxin a Injections and Subcutaneous Curettage in the Treatment of Axillary Hyperhidrosis

    Science.gov (United States)

    Budamakuntla, Leelavathy; Loganathan, Eswari; George, Anju; Revanth, BN; Sankeerth, V; Sarvjnamurthy, Sacchidananda Aradhya

    2017-01-01

    Background: Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands. Aims and Objectives: The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis. Materials and Methods: Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure. Results: At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method. Conclusion: Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events. PMID

  19. Gender differences in subcutaneous and perirenal fat distribution

    OpenAIRE

    Eisner, BH; Zargooshi, J; Berger, AD; Cooperberg, MR; Doyle, SM; Sheth, S; Stoller, ML

    2010-01-01

    Purpose: Body mass index (BMI) has been shown to influence the outcome of various surgical procedures. The purpose of this study is to assess the relationship between BMI, gender, and the distribution of subcutaneous and perirenal fat. Methods: A retrospective review was performed for 123 patients who underwent radical or partial nephrectomy. Preoperative CT scans were reviewed by two independent observers. Subcutaneous fat was measured at three locations and perirenal fat was measured at six...

  20. Selection of patients for sublingual versus subcutaneous immunotherapy.

    Science.gov (United States)

    Larenas Linnemann, Désirée E S; Blaiss, Michael S

    2014-01-01

    Allergen immunotherapy is the sole treatment for IgE-mediated allergic diseases directed at the underlying mechanism. The two widely accepted administration routes are sublingual (SLIT) and subcutaneous (SCIT). We reviewed how patients should best be selected for immunotherapy and how the optimal administration route can be defined. Before deciding SCIT or SLIT, appropriate selection of patients for allergen immunotherapy (AIT) is mandatory. To be eligible for AIT, subjects must have a clear medical history of allergic disease, with exacerbation of symptoms on exposure to one or more allergens and a corresponding positive skin or in vitro test. Then the route of administration should be based on: published evidence of clinical and immunologic efficacy (which varies per allergic disease and per allergen); mono- or multi-allergen immunotherapy, for SLIT multi-allergen immunotherapy was not effective; safety: adverse events with SLIT are more frequent, but less severe; and, costs and patient preferences, closely related to adherence issues. All these are discussed in the article.

  1. Subcutaneous autologous serum therapy in chronic spontaneous urticaria

    Directory of Open Access Journals (Sweden)

    Kiran Vasant Godse

    2017-01-01

    Full Text Available Background: There is a felt need for trying newer therapeutic modalities in patients with chronic spontaneous urticaria, especially in the subset of patients classified as non-responders to antihistamines. Autologous serum therapy is an upcoming modality of treatment, and we decided to study its efficacy by subcutaneous route. Aims: To evaluate the effectiveness of subcutaneous autologous serum therapy (AST in CSU. Methods: This was a single blind, placebo-controlled parallel group, randomized, controlled study. Twenty-four patients with CSU (11M: 13 F were given subcutaneous AST and seventeen patients (7 M: 10F patients were given subcutaneous injection normal saline (placebo, along with levocetirizine in an on-demand basis in both groups. Results: Urticaria activity score (UAS came down from 35.74 to 7 at the end of 9 weeks and the patients' requirement of antihistamines also reduced remarkably from 5.8 to 1.7 per week in the serum group. Sub-cutaneous saline group did not show statistically significant fall in UAS. Saline group showed UAS 32.8 at zero week to 22.1 at the end of 9 weeks. DLQI showed significant fall in serum group, from 14.26 to 4 at the end of 9 weeks. Conclusion: Subcutaneous autoserum therapy is effective in treatment of CSU.

  2. Gender differences in subcutaneous and perirenal fat distribution.

    Science.gov (United States)

    Eisner, Brian H; Zargooshi, Javaad; Berger, Aaron D; Cooperberg, Matthew R; Doyle, Sean M; Sheth, Sonali; Stoller, Marshall L

    2010-11-01

    Body mass index (BMI) has been shown to influence the outcome of various surgical procedures. The purpose of this study is to assess the relationship between BMI, gender, and the distribution of subcutaneous and perirenal fat. A retrospective review was performed for 123 patients who underwent radical or partial nephrectomy. Preoperative CT scans were reviewed by two independent observers. Subcutaneous fat was measured at three locations and perirenal fat was measured at six locations. Statistical analysis was performed using the Student's t test and the Pearson's correlation coefficient. Mean anterior subcutaneous fat was significantly greater in females than in males (2.54 vs. 1.78 cm, p fat (2.78 vs. 2.21 cm, p = 0.03). With regard to perirenal fat, men were greater than women for all perirenal locations around the left kidney. For the right kidney, men were greater than women for four out of six perirenal positions. In both men and women, BMI was strongly correlated with subcutaneous fat. However, BMI was weakly correlated with perirenal fat. Women exceed men in subcutaneous fat, while men exceed women in perirenal fat. Obese patients are very likely to have large amounts of subcutaneous fat, but will not necessarily have proportionally increased fat around their kidneys when compared to the patients with lower BMI. These differences may have important implications for surgical approaches to the kidney.

  3. Stimulation of soluble guanylate cyclase prevents cigarette smoke-induced pulmonary hypertension and emphysema.

    Science.gov (United States)

    Weissmann, Norbert; Lobo, Borja; Pichl, Alexandra; Parajuli, Nirmal; Seimetz, Michael; Puig-Pey, Raquel; Ferrer, Elisabet; Peinado, Víctor I; Domínguez-Fandos, David; Fysikopoulos, Athanasios; Stasch, Johannes-Peter; Ghofrani, Hossein A; Coll-Bonfill, Núria; Frey, Reiner; Schermuly, Ralph T; García-Lucio, Jéssica; Blanco, Isabel; Bednorz, Mariola; Tura-Ceide, Olga; Tadele, Elsa; Brandes, Ralf P; Grimminger, Jan; Klepetko, Walter; Jaksch, Peter; Rodriguez-Roisin, Robert; Seeger, Werner; Grimminger, Friedrich; Barberà, Joan A

    2014-06-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of death worldwide. No therapy stopping progress of the disease is available. To investigate the role of the soluble guanylate cyclase (sGC)-cGMP axis in development of lung emphysema and pulmonary hypertension (PH) and to test whether the sGC-cGMP axis is a treatment target for these conditions. Investigations were performed in human lung tissue from patients with COPD, healthy donors, mice, and guinea pigs. Mice were exposed to cigarette smoke (CS) for 6 hours per day, 5 days per week for up to 6 months and treated with BAY 63-2521. Guinea pigs were exposed to CS from six cigarettes per day for 3 months, 5 days per week and treated with BAY 41-2272. Both BAY compounds are sGC stimulators. Gene and protein expression analysis were performed by quantitative real-time polymerase chain reaction and Western blotting. Lung compliance, hemodynamics, right ventricular heart mass alterations, and alveolar and vascular morphometry were performed, as well as inflammatory cell infiltrate assessment. In vitro assays of cell adhesion, proliferation, and apoptosis have been done. The functionally essential sGC β1-subunit was down-regulated in patients with COPD and in CS-exposed mice. sGC stimulators prevented the development of PH and emphysema in the two different CS-exposed animal models. sGC stimulation prevented peroxynitrite-induced apoptosis of alveolar and endothelial cells, reduced CS-induced inflammatory cell infiltrate in lung parenchyma, and inhibited adhesion of CS-stimulated neutrophils. The sGC-cGMP axis is perturbed by chronic exposure to CS. Treatment of COPD animal models with sGC stimulators can prevent CS-induced PH and emphysema.

  4. Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality

    Science.gov (United States)

    Kravchenko, Julia; Akushevich, Igor; Abernethy, Amy P; Holman, Sheila; Ross, William G; Lyerly, H Kim

    2014-01-01

    Background The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations. Materials and methods We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993–2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths. Results Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths–with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths–with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted. Conclusion Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina. PMID:25018627

  5. Blockade of RAGE ameliorates elastase-induced emphysema development and progressionviaRAGE-DAMP signaling.

    Science.gov (United States)

    Lee, Hanbyeol; Park, Jeong-Ran; Kim, Woo Jin; Sundar, Isaac K; Rahman, Irfan; Park, Sung-Min; Yang, Se-Ran

    2017-05-01

    The receptor for advanced glycan end products (RAGE) has been identified as a susceptibility gene for chronic obstructive pulmonary disease (COPD) in genome-wide association studies (GWASs). However, less is known about how RAGE is involved in the pathogenesis of COPD. To determine the molecular mechanism by which RAGE influences COPD in experimental COPD models, we investigated the efficacy of the RAGE-specific antagonist FPS-ZM1 administration in in vivo and in vitro COPD models. We injected elastase intratracheally and the RAGE antagonist FPS-ZM1 in mice, and the infiltrated inflammatory cells and cytokines were assessed by ELISA. Cellular expression of RAGE was determined in protein, serum, and bronchoalveolar lavage fluid of mice and lungs and serum of human donors and patients with COPD. Downstream damage-associated molecular pattern (DAMP) pathway activation in vivo and in vitro and in patients with COPD was assessed by immunofluorescence staining, Western blot analysis, and ELISA. The expression of membrane RAGE in initiating the inflammatory response and of soluble RAGE acting as a decoy were associated with up-regulation of the DAMP-related signaling pathway via Nrf2. FPS-ZM1 administration significantly reversed emphysema in the lung of mice. Moreover, FPS-ZM1 treatment significantly reduced lung inflammation in Nrf2 +/+ , but not in Nrf2 -/- mice. Thus, our data indicate for the first time that RAGE inhibition has an essential protective role in COPD. Our observation of RAGE inhibition provided novel insight into its potential as a therapeutic target in emphysema/COPD.-Lee, H., Park, J.-R., Kim, W. J., Sundar, I. K., Rahman, I., Park, S.-M., Yang. S.-R. Blockade of RAGE ameliorates elastase-induced emphysema development and progression via RAGE-DAMP signaling. © FASEB.

  6. Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality.

    Science.gov (United States)

    Kravchenko, Julia; Akushevich, Igor; Abernethy, Amy P; Holman, Sheila; Ross, William G; Lyerly, H Kim

    2014-01-01

    The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations. We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993-2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths. Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths-with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths-with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted. Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina.

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

    Science.gov (United States)

    Strange, Charlie; Herth, Felix J F; Kovitz, Kevin L; McLennan, Geoffrey; Ernst, Armin; Goldin, Jonathan; Noppen, Marc; Criner, Gerard J; Sciurba, Frank C

    2007-07-03

    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. 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. 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 debilitating disease. ClinicalTrials.gov: NCT00129584.

  8. 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

  9. Automated prediction of emphysema visual score using homology-based quantification of low-attenuation lung region.

    Directory of Open Access Journals (Sweden)

    Mizuho Nishio

    Full Text Available The purpose of this study was to investigate the relationship between visual score of emphysema and homology-based emphysema quantification (HEQ and evaluate whether visual score was accurately predicted by machine learning and HEQ.A total of 115 anonymized computed tomography images from 39 patients were obtained from a public database. Emphysema quantification of these images was performed by measuring the percentage of low-attenuation lung area (LAA%. The following values related to HEQ were obtained: nb0 and nb1. LAA% and HEQ were calculated at various threshold levels ranging from -1000 HU to -700 HU. Spearman's correlation coefficients between emphysema quantification and visual score were calculated at the various threshold levels. Visual score was predicted by machine learning and emphysema quantification (LAA% or HEQ. Random Forest was used as a machine learning algorithm, and accuracy of prediction was evaluated by leave-one-patient-out cross validation. The difference in the accuracy was assessed using McNemar's test.The correlation coefficients between emphysema quantification and visual score were as follows: LAA% (-950 HU, 0.567; LAA% (-910 HU, 0.654; LAA% (-875 HU, 0.704; nb0 (-950 HU, 0.552; nb0 (-910 HU, 0.629; nb0 (-875 HU, 0.473; nb1 (-950 HU, 0.149; nb1 (-910 HU, 0.519; and nb1 (-875 HU, 0.716. The accuracy of prediction was as follows: LAA%, 55.7% and HEQ, 66.1%. The difference in accuracy was statistically significant (p = 0.0290.LAA% and HEQ at -875 HU showed a stronger correlation with visual score than those at -910 or -950 HU. HEQ was more useful than LAA% for predicting visual score.

  10. Quantitative study of {sup 99m}Tc-technegas SPECT for ventilatory impairment in pulmonary emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Mitani, Masahiro; Katoh, Tsutomu [Sumitomo Besshi Hospital, Niihama, Ehime (Japan); Satoh, Katashi; Takahashi, Kazue; Kobayashi, Takuya; Yamamoto, Yuka; Nishiyama, Yoshihiro; Ohkawa, Motoomi; Hosokawa, Nobuyuki

    1999-05-01

    {sup 99m}Tc-Technegas scintigraphy is used to evaluate ventilation abnormalities in patients with pulmonary emphysema. Although abnormalities of ventilation distribution are easy to find, no objective index exits. Evaluation is subjective and differs with each radiologist. Thus, it is difficult to compare cases and the clinical course in the same case. The present study for quantitative evaluation demonstrated an excellent correlations between mean voxel values of the lung and stage classification. Furthermore, a correlation was observed between the mean and FEV1.0%. These findings indicate that the quantitative analysis of SPECT data is useful for classifying clinical stage and comparing cases. (author)

  11. Pleuropulmonary blastoma type I following resection of incidentally found congenital lobar emphysema.

    LENUS (Irish Health Repository)

    Walsh, S

    2009-07-01

    Pleuropulmonary blastoma (PPB) is an aggressive tumour accounting for less than 1% of all primary malignant lung tumours in the paediatric population. It can be associated with cystic pulmonary lesions, which may be evident at the time of diagnosis or predate the appearance of the tumour. There are contradictory reports about the value of prophylactic resection of pulmonary cysts in protecting patients from developing PPB. We report an individual case where asymptomatic congenital lobar emphysema was incidentally picked up on CXR. Following a period of surveillance the lesion was resected due to increasing size. The histology of the lesion revealed PPB Type I.

  12. Spontaneous Mediastinal Emphysema Associated with the Use of Synthetic Cannabinoid (Bonsai).

    Science.gov (United States)

    Chousein, Efsun Gonca Uğur; İliaz, Sinem; Nizam, Merve; Öztürk, Sakine; Çağlar, Emel

    2016-01-01

    Spontaneous Mediastinal Emphysema (SME), which is a rarely seen case is defined as the detection of free air in the mediastinum without any trauma. Although rare, some cases secondary to drug use have been reported. In this study, two SME cases that developed due to the use of a synthetic cannabinoid known as "bonzai", which has recently become widespread in Turkey, are presented. We would like to emphasize that SME should also be considered in the differential diagnosis of patients who present with the symptoms of chest pain and dyspnea and have a history of drug use.

  13. Optimizing subcutaneous injection of the gonadotropin-releasing hormone receptor antagonist degarelix.

    Science.gov (United States)

    Barkin, Jack; Burton, Shelley; Lambert, Carole

    2016-02-01

    The gonadotropin-releasing hormone (GnRH) receptor antagonist degarelix has several unique characteristics compared to luteinizing hormone-releasing hormone (LHRH) analogs used in the management of prostate cancer. Notable differences of GnRH receptor antagonists include no flare reaction, and a more rapid suppression of testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prostate-specific antigen (PSA) compared to LHRH analogs. Despite emerging evidence supporting the use of GnRH receptor antagonists over the more widely used LHRH analogs in the management of prostate cancer, physicians may be reluctant to prescribe degarelix. They may be concerned about patient complaints about injection-site reactions (ISRs). The subcutaneous injection of degarelix has been associated with a higher rate of ISRs compared with the intramuscular injections of LHRH analogs. This "How I Do It" article describes techniques and strategies that have been developed by physicians and nurses to reduce the discomfort associated with the subcutaneous delivery of degarelix.

  14. Bacteria Associated with Subcutaneous Abscesses of Cattle Caused by Hypoderma spp Larvae in North of Iran

    Directory of Open Access Journals (Sweden)

    Hossein Tajik

    2010-09-01

    Full Text Available This study was performed from February to April 2006; several visits were made to abattoirs in the north of Iran for Hypoderma spp infestation. Necropsy inspection of slaughtered and skinned animals were carried out by examination of the inner skin surface and subcutaneous tissues. Warbles were isolated by squeezing nodules from subcutaneous tissues. In the case of abscess presence, aseptic sample were taken from abscesses. The parasitological and bacteriological examinations were performed on the samples. The results indicated that 104 out of 958 of slaughtered animals were infested to Hypoderma spp in which 48 (46.15 %, 34 (32.69 % and 22 (21.15 % were infested to Hypoderma bovis, Hypoderma lineatum and both species, respectively. Following bacterial analysis, the following bacteria were isolated: Escherichia coli, Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis and Klebsiella pneumonia.

  15. Rudhe syndrome: reversible right middle lobe emphysema in infants with left-to-right shunts - an historical review

    International Nuclear Information System (INIS)

    Collins, Lee K.; Levin, Terry L.; Berdon, Walter E.; Cowles, Robert A.; Newman, Beverley

    2010-01-01

    In 1971, the Swedish radiologist Ulf Rudhe wrote a provocative paper on right middle lobe emphysema in infants with left-to-right shunts in which he suggested cardiac surgery rather than lung resection. At the time, this was counter to accepted medical practice. Earlier diagnosis and better medical management of ventricular septal defect in infants has proved Rudhe correct. However, two current cases of large left-to-right shunts in infants with emphysema of the right middle lobe prompt this historical review of what seemed a closed-episode in pediatric cardiac surgery. (orig.)

  16. Subcutaneous injection is a simple and reproducible option to restore parathyroid function after total parathyroidectomy in patients with secondary hyperparathyroidism.

    Science.gov (United States)

    Ng, Jeremy C F; Wang, Weining; Chua, Min-Jia; Tan, Mui-Suan; Tan, Ngian Chye; Soo, Khee-Chee; Tan, Hiang Khoon; Iyer, N Gopalakrishna

    2014-04-01

    Secondary hyperparathyroidism is a common clinical problem seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. In patients with severe persistent hyperparathyroidism, parathyroidectomies are often required. We sought to evaluate the feasibility and efficacy of total parathyroidectomy followed by subcutaneous injection of parathyroid autograft compared with surgical implantation. We conducted a retrospective study of 132 patients with confirmed diagnoses of ESRD treated with hemodialysis or peritoneal dialysis, with secondary hyperparathyroidism who had undergone total parathyroidectomies. Clinical and biochemical characteristics, including preoperative and postoperative intact parathyroid hormone levels were recorded and compared between patients who had undergone subcutaneous injection or surgical implantation of autograft. From February 2005 to February 2012, 132 patients who had undergone total parathyroidectomies were included in our study. To compare the techniques of subcutaneous injection and surgical implantation, pre- and postoperative biochemistry was recorded and analyzed. Preoperative biochemistry was comparable in both groups. However, autograft recovery was significantly faster in the group with subcutaneous injection compared with surgical implantation (P = .03). Median time to parathyroid recovery was 2 months for injection compared with 9 months for implantation. There was no remarkable difference in the recurrence rates between the 2 groups. Subcutaneous injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of surgical implantation. Copyright © 2014 Mosby, Inc. All rights reserved.

  17. Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes

    DEFF Research Database (Denmark)

    Roze, S.; Smith-Palmer, J.; Valentine, W.

    2015-01-01

    Aim: Continuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type 1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically...

  18. Transcriptomic Analysis of Lung Tissue from Cigarette Smoke-Induced Emphysema Murine Models and Human Chronic Obstructive Pulmonary Disease Show Shared and Distinct Pathways.

    Science.gov (United States)

    Yun, Jeong H; Morrow, Jarrett; Owen, Caroline A; Qiu, Weiliang; Glass, Kimberly; Lao, Taotao; Jiang, Zhiqiang; Perrella, Mark A; Silverman, Edwin K; Zhou, Xiaobo; Hersh, Craig P

    2017-07-01

    Although cigarette smoke (CS) is the primary risk factor for chronic obstructive pulmonary disease (COPD), the underlying molecular mechanisms for the significant variability in developing COPD in response to CS are incompletely understood. We performed lung gene expression profiling of two different wild-type murine strains (C57BL/6 and NZW/LacJ) and two genetic models with mutations in COPD genome-wide association study genes (HHIP and FAM13A) after 6 months of chronic CS exposure and compared the results to human COPD lung tissues. We identified gene expression patterns that correlate with severity of emphysema in murine and human lungs. Xenobiotic metabolism and nuclear erythroid 2-related factor 2-mediated oxidative stress response were commonly regulated molecular response patterns in C57BL/6, Hhip +/- , and Fam13a -/- murine strains exposed chronically to CS. The CS-resistant Fam13a -/- mouse and NZW/LacJ strain revealed gene expression response pattern differences. The Fam13a -/- strain diverged in gene expression compared with C57BL/6 control only after CS exposure. However, the NZW/LacJ strain had a unique baseline expression pattern, enriched for nuclear erythroid 2-related factor 2-mediated oxidative stress response and xenobiotic metabolism, and converged to a gene expression pattern similar to the more susceptible wild-type C57BL/6 after CS exposure. These results suggest that distinct molecular pathways may account for resistance to emphysema. Surprisingly, there were few genes commonly modulated in mice and humans. Our study suggests that gene expression responses to CS may be largely species and model dependent, yet shared pathways could provide biologically significant insights underlying individual susceptibility to CS.

  19. The effects of dynamic hyperinflation on CT emphysema measurements in patients with COPD

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Giordano Rafael Tronco, E-mail: grtalves@gmail.com [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil); Marchiori, Edson [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil); Irion, Klaus Loureiro [Radiology Department, Liverpool Heart and Chest Hospital (United Kingdom); Teixeira, Paulo José Zimmerman [Pulmonology Department, Federal University of Health Sciences of Porto Alegre (Brazil); Berton, Danilo Cortozi [Pulmonology Department, Federal University of Rio Grande do Sul (Brazil); Rubin, Adalberto Sperb [Pulmonology Department, Federal University of Health Sciences of Porto Alegre (Brazil); Hochhegger, Bruno [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil)

    2014-12-15

    Objectives: Dynamic hyperinflation (DH) significantly affects dyspnea and intolerance to exercise in patients with chronic obstructive pulmonary disease (COPD). Quantitative computed tomography (QCT) of the chest is the modality of choice for quantification of the extent of anatomical lung damage in patients with COPD. The purpose of this article is to assess the effects of DH on QCT measurements. Methods: The study sample comprised patients with Global initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV COPD referred for chest CT. We examined differences in total lung volume (TLV), emphysema volume (EV), and emphysema index (EI) determined by QCT before and after DH induction by metronome-paced tachypnea (MPT). Initial (resting) and post-MPT CT examinations were performed with the same parameters. Results: Images from 66 CT scans (33 patients) were evaluated. EV and EI, but not TLV, increased significantly (p < 0.0001) after DH induction. Conclusion: QCT showed significant increases in EV and EI after MPT-induced DH in patients with GOLD stages III and IV COPD. For longitudinal assessment of patients with COPD using QCT, we recommend the application of a pre-examination rest period, as DH could mimic disease progression. QCT studies of the effects of DH-preventive therapy before exercise could expand our knowledge of effective measures to delay DH-related progression of COPD.

  20. Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

    2015-12-01

    Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

  1. Rare case of pneumorrhachis, pneumomediastinum, pneumothorax, and surgical emphysema secondary to bronchial asthma

    Directory of Open Access Journals (Sweden)

    Mahajan PS

    2014-03-01

    Full Text Available Parag Suresh Mahajan,1 Nasser Jassim Al Maslamani,1 Nishan K Purayil2 1Department of Radiology, 2Accident and Emergency Department, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar Abstract: Air localized within the spinal canal is called pneumorrhachis. In the case of pneumorrhachis, air can be present in the extradural, the intradural, or the subarachnoid space of the spinal canal. The air within the soft tissue of the posterior mediastinum may dissect along fascial planes, through the intervertebral neural foramina, and into the extradural or the subarachnoid space. Nontraumatic pneumorrhachis is a rare presentation. Most of the time, pneumorrhachis is asymptomatic, remains localized, and resolves spontaneously. There are very few reports of combined presence of pneumomediastinum and extradural pneumorrhachis not associated with thoracic injury in the published literature. We report a rare case of pneumorrhachis, pneumomediastinum, pneumothorax, and surgical emphysema in an adult female patient developed after a bout of violent cough related to bronchial asthma. Keywords: pneumorrhachis, pneumomediastinum, pneumothorax, surgical emphysema, asthma

  2. Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

    Directory of Open Access Journals (Sweden)

    Mitra Jabalameli

    2014-01-01

    Full Text Available Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control. Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test. Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05 and mean satisfactory (P value = 0.02 was statistically significant between groups. Other parameters were not statistically significant. Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients.

  3. Clinical Trial of Subcutaneous Steroid Injection in Patients with Migraine Disorder

    Directory of Open Access Journals (Sweden)

    Karim Nikkhah

    2016-02-01

    Full Text Available Background: Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients. Methods: Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area (exactly at retromastoid cervicocranial junction and the other two injections in the lower medial frontal area (exactly at medial right and left eyebrows. A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis. Results: 504 patients (378 females, 126 males with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection. Conclusion: Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache.

  4. Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?

    NARCIS (Netherlands)

    A.H. Kars (Alice); G. Goorden; Th. Stijnen (Theo); J.M. Bogaard (Jan); A.F.M. Verbraak (Anton); C. Hilvering

    1995-01-01

    textabstractIt has been postulated that serial inhomogeneity of ventilation in the peripheral airways in emphysema is represented by the shape of expiratory carbon dioxide tension versus volume curve. We examined the diagnostic value of this test in patients with various degrees of

  5. Extensive Analysis of Elastase-Induced Pulmonary Emphysema in Rats: ALP in the Lung, a New Biomarker for Disease Progression?

    Science.gov (United States)

    Inoue, Ken-ichiro; Koike, Eiko; Yanagisawa, Rie; Takano, Hirohisa

    2010-01-01

    It is accepted that pulmonary exposure of rodents to porcine pancreatic elastase (ELT) induces lesions that morphologically resemble human emphysema. Nonetheless, extensive analysis of this model has rarely been conducted. The present study was designed to extensively examine the effects of ELT on lung inflammation, cell damage, emphysematous change, and cholinergic reactivity in rats. Intratracheal administration of two doses of ELT induced 1) a proinflammatory response in the lung that was characterized by significant infiltration of macrophages and an increased level of interleukin-1β in lung homogenates, 2) lung cell damage as indicated by higher levels of total protein, lactate dehydrogenase, and alkaline phosphatase (ALP) in lung homogenates, 3) emphysema-related morphological changes including airspace enlargement and progressive destruction of alveolar wall structures, and 4) airway responsiveness to methacholine including an augmented Rn value. In addition, ELT at a high dose was more effective than that at a low dose. This is the novel study to extensively analyze ELT-induced lung emphysema, and the analysis might be applied to future investigations that evaluate new therapeutic agents or risk factors for pulmonary emphysema. In particular, ALP in lung homogenates might be a new biomarker for the disease progression/exacerbation. PMID:20216950

  6. Influence of Sinogram-Affirmed Iterative Reconstruction on Computed Tomography-Based Lung Volumetry and Quantification of Pulmonary Emphysema.

    Science.gov (United States)

    Baumueller, Stephan; Hilty, Regina; Nguyen, Thi Dan Linh; Weder, Walter; Alkadhi, Hatem; Frauenfelder, Thomas

    2016-01-01

    The purpose of this study was to evaluate the influence of sinogram-affirmed iterative reconstruction (SAFIRE) on quantification of lung volume and pulmonary emphysema in low-dose chest computed tomography compared with filtered back projection (FBP). Enhanced or nonenhanced low-dose chest computed tomography was performed in 20 patients with chronic obstructive pulmonary disease (group A) and in 20 patients without lung disease (group B). Data sets were reconstructed with FBP and SAFIRE strength levels 3 to 5. Two readers semiautomatically evaluated lung volumes and automatically quantified pulmonary emphysema, and another assessed image quality. Radiation dose parameters were recorded. Lung volume between FBP and SAFIRE 3 to 5 was not significantly different among both groups (all P > 0.05). When compared with those of FBP, total emphysema volume was significantly lower among reconstructions with SAFIRE 4 and 5 (mean difference, 0.56 and 0.79 L; all P lung volume measurements, although quantification of lung emphysema is affected at higher strength levels.

  7. Deletion of vitamin D receptor leads to premature emphysema/COPD by increased matrix metalloproteinases and lymphoid aggregates formation

    International Nuclear Information System (INIS)

    Sundar, Isaac K.; Hwang, Jae-Woong; Wu, Shaoping; Sun, Jun; Rahman, Irfan

    2011-01-01

    Research highlights: → Vitamin D deficiency is linked to accelerated decline in lung function. → Levels of vitamin D receptor (VDR) are decreased in lungs of patients with COPD. → VDR knock-out mouse showed increased lung inflammation and emphysema. → This was associated with decline in lung function and increased MMPs. → VDR knock-out mouse model is useful for studying the mechanisms of lung diseases. -- Abstract: Deficiency of vitamin D is associated with accelerated decline in lung function. Vitamin D is a ligand for nuclear hormone vitamin D receptor (VDR), and upon binding it modulates various cellular functions. The level of VDR is reduced in lungs of patients with chronic obstructive pulmonary disease (COPD) which led us to hypothesize that deficiency of VDR leads to significant alterations in lung phenotype that are characteristics of COPD/emphysema associated with increased inflammatory response. We found that VDR knock-out (VDR -/- ) mice had increased influx of inflammatory cells, phospho-acetylation of nuclear factor-kappaB (NF-κB) associated with increased proinflammatory mediators, and up-regulation of matrix metalloproteinases (MMPs) MMP-2, MMP-9, and MMP-12 in the lung. This was associated with emphysema and decline in lung function associated with lymphoid aggregates formation compared to WT mice. These findings suggest that deficiency of VDR in mouse lung can lead to an early onset of emphysema/COPD because of chronic inflammation, immune dysregulation, and lung destruction.

  8. The effect of inhaled corticosteroids on the development of emphysema in smokers assessed by annual computed tomography

    DEFF Research Database (Denmark)

    Shaker, Saher B; Dirksen, Asger; Ulrik, Charlotte S

    2009-01-01

    with biannual spirometry and annual CT and comprehensive lung function tests (LFT). CT images were analysed using Pulmo-CMS software. LD was derived from a pixel-density histogram of the whole lung as the 15th percentile density (PD15) and the relative area of emphysema at a threshold of -910 Hounsfield units...

  9. Characteristics of candidates for lung transplantation due to chronic obstructive pulmonary disease and alpha-1 antitrypsin deficiency emphysema.

    Science.gov (United States)

    Giacoboni, Daniela; Barrecheguren, Miriam; Esquinas, Cristina; Rodríguez, Esther; Berastegui, Cristina; López-Meseguer, Manuel; Monforte, Víctor; Bravo, Carlos; Pirina, Pietro; Miravitlles, Marc; Román, Antonio

    2015-08-01

    COPD and emphysema due to alpha-1 antitrypsin deficiency (AATD) are the first and fourth indications for lung transplantation worldwide, respectively. Despite this, there is little information regarding the health status of these patients at the time of transplantation. Patients who received a lung transplant in the Hospital Vall d'Hebron between July 1993 and August 2013 were identified and data from the evaluation prior to the transplant were collected. A total of 217 patients who received a lung transplant for COPD and 19 in whom the indication was AATD were included. These patients were severely impaired at the time of the evaluation for lung transplantation, although the trend in recent years has been to evaluate patients at earlier stages of the disease. Baseline characteristics were similar in both groups except that patients with AATD were younger [43 (7.7) vs. 53.6 (6.1) years old, P<.001], with less exposure to tobacco [23.9 (15) vs. 50 (29) packs-year, P<002] and lower PCO2 [41.7 (7.6) vs. 47.9 (9.7) mmHg, P<.004]. The number of patients receiving a lung transplant for COPD has progressively increased and the tendency is to perform the evaluation in earlier stages of the disease. Patients receiving transplants for COPD and AATD had similar characteristics at the time of the evaluation, although AATD patients were younger and had less exposure to tobacco and lower PCO2. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Skin temperature and subcutaneous adipose blood flow in man

    DEFF Research Database (Denmark)

    Astrup, A; Bülow, J; Madsen, J

    1980-01-01

    The abdominal subcutaneous adipose tissue blood flow (ATBF) was measured bilaterally by the 133Xe washout method. At one side of the skin (epicutaneous) temperature was varied with a temperature blanket, the other side served as control. There was a significant (P less than 0.001) positive...... correlation between skin temperature and ATBF. In the range from 25 to 37 degrees CATBF increased 9% of the control flow on average per centigrade increase in skin temperature. ATBF at the control side was uninfluenced by the contralateral variations in skin temperature. Although no better correlation could...... be demonstrated between ATBF and subcutaneous temperature than between ATBF and skin temperature, arguments are presented in favour of the hypothesis that ATBF is influenced by the subcutaneous temperature rather than via reflexes from the skin. Infiltration of the 133Xe depots with 20 microgram histamine...

  11. Successful treatment of systemic lupus erythematosus with subcutaneous immunoglobulin.

    Science.gov (United States)

    Brasileiro, A; Fonseca Oliveira, J; Pinheiro, S; Paiva-Lopes, M J

    2016-05-01

    The therapeutic efficacy of high-dose intravenous immunoglobulin in systemic lupus erythematosus (SLE) patients is well established. However, side effects might limit its use and lead to the consideration of therapeutic alternatives, such as the subcutaneous formulation of immunoglobulin, which has been used in some patients with other autoimmune diseases. We report a case of SLE refractory to classical therapies. High-dose intravenous immunoglobulin was effective, but gave rise to significant side effects. The patient was successfully treated with subcutaneous human immunoglobulin, achieving and maintaining clinical and laboratory remission. A lower immunoglobulin dose was needed and no side effects were observed, compared to the intravenous administration. Subcutaneous immunoglobulin could be a better-tolerated and cost-saving therapeutic option for select SLE patients. © The Author(s) 2016.

  12. Subcutaneous steroid injection as treatment for chalazion: prospective case series.

    Science.gov (United States)

    Ho, S Y; Lai, J S M

    2002-02-01

    To study the efficacy of subcutaneous steroid injection in the treatment of chalazion. Prospective consecutive case series. University teaching hospital, Hong Kong. Patients with chalazion presenting to the out-patient clinic of the Department of Ophthalmology at the Prince of Wales Hospital from January to June 1998. Size of the chalazion after steroid injection treatment. Forty-eight consecutive patients with chalazion were treated with injection of triamcinolone into the subcutaneous tissue around the lesion. In 43 (89.6%) patients, the lesion subsided completely. Twenty-six (54.2%) patients had lesions that subsided with one injection. The size and duration of the chalazion at presentation did not significantly affect the outcome of the treatment. Two patients developed depigmentation of the skin at the site of injection. No other major complications were encountered. Subcutaneous injection of the steroid triamcinolone acetonide appears to be a simple and effective treatment for chalazion. Further comparative clinical trials are indicated.

  13. Subcutaneous basidiobolomycosis: A Case Report | Sackey | Ghana ...

    African Journals Online (AJOL)

    A 3 year old girl presented with ulcerations on the right thigh for one month, and painful swelling of the right leg and right buttock for six months. The right lower limb and vulva were swollen, tender and hard with hyperpigmentation and inguinal lymphadenopathy. She had severe anaemia, eosinophilia and negative serology ...

  14. Microstructural inhomogeneity of electrical conductivity in subcutaneous fat tissue.

    Directory of Open Access Journals (Sweden)

    Ilja L Kruglikov

    Full Text Available Microscopic peculiarities stemming from a temperature increase in subcutaneous adipose tissue (sWAT after applying a radio-frequency (RF current, must be strongly dependent on the type of sWAT. This effect is connected with different electrical conductivities of pathways inside (triglycerides in adipocytes and outside (extra-cellular matrix the cells and to the different weighting of these pathways in hypertrophic and hyperplastic types of sWAT. The application of the RF current to hypertrophic sWAT, which normally has a strongly developed extracellular matrix with high concentrations of hyaluronan and collagen in a peri-cellular space of adipocytes, can produce, micro-structurally, a highly inhomogeneous temperature distribution, characterized by strong temperature gradients between the peri-cellular sheath of the extra-cellular matrix around the hypertrophic adipocytes and their volumes. In addition to normal temperature effects, which are generally considered in body contouring, these temperature gradients can produce thermo-mechanical stresses on the cells' surfaces. Whereas these stresses are relatively small under normal conditions and cannot cause any direct fracturing or damage of the cell structure, these stresses can, under some supportive conditions, be theoretically increased by several orders of magnitude, causing the thermo-mechanical cell damage. This effect cannot be realized in sWAT of normal or hyperplastic types where the peri-cellular structures are under-developed. It is concluded that the results of RF application in body contouring procedures must be strongly dependent on the morphological structure of sWAT.

  15. Coal Mine Dust Desquamative Chronic Interstitial Pneumonia: A Precursor of Dust-Related Diffuse Fibrosis and of Emphysema

    Directory of Open Access Journals (Sweden)

    Tomislav M Jelic

    2017-07-01

    Full Text Available Background: Diseases associated with coal mine dust continue to affect coal miners. Elucidation of initial pathological changes as a precursor of coal dust-related diffuse fibrosis and emphysema, may have a role in treatment and prevention. Objective: To identify the precursor of dust-related diffuse fibrosis and emphysema. Methods: Birefringent silica/silicate particles were counted by standard microscope under polarized light in the alveolar macrophages and fibrous tissue in 25 consecutive autopsy cases of complicated coal worker's pneumoconiosis and in 21 patients with tobacco-related respiratory bronchiolitis. Results: Coal miners had 331 birefringent particles/high power field while smokers had 4 (p<0.001. Every coal miner had intra-alveolar macrophages with silica/silicate particles and interstitial fibrosis ranging from minimal to extreme. All coal miners, including those who never smoked, had emphysema. Fibrotic septa of centrilobular emphysema contained numerous silica/silicate particles while only a few were present in adjacent normal lung tissue. In coal miners who smoked, tobacco-associated interstitial fibrosis was replaced by fibrosis caused by silica/silicate particles. Conclusion: The presence of silica/silicate particles and anthracotic pigment-laden macrophages inside the alveoli with various degrees of interstitial fibrosis indicated a new disease: coal mine dust desquamative chronic interstitial pneumonia, a precursor of both dust-related diffuse fibrosis and emphysema. In studied coal miners, fibrosis caused by smoking is insignificant in comparison with fibrosis caused by silica/silicate particles. Counting birefringent particles in the macrophages from bronchioalveolar lavage may help detect coal mine dust desquamative chronic interstitial pneumonia, and may initiate early therapy and preventive measures.

  16. Acute and chronic effects of treatment with mesenchymal stromal cells on LPS-induced pulmonary inflammation, emphysema and atherosclerosis development.

    Directory of Open Access Journals (Sweden)

    P Padmini S J Khedoe

    Full Text Available COPD is a pulmonary disorder often accompanied by cardiovascular disease (CVD, and current treatment of this comorbidity is suboptimal. Systemic inflammation in COPD triggered by smoke and microbial exposure is suggested to link COPD and CVD. Mesenchymal stromal cells (MSC possess anti-inflammatory capacities and MSC treatment is considered an attractive treatment option for various chronic inflammatory diseases. Therefore, we investigated the immunomodulatory properties of MSC in an acute and chronic model of lipopolysaccharide (LPS-induced inflammation, emphysema and atherosclerosis development in APOE*3-Leiden (E3L mice.Hyperlipidemic E3L mice were intranasally instilled with 10 μg LPS or vehicle twice in an acute 4-day study, or twice weekly during 20 weeks Western-type diet feeding in a chronic study. Mice received 0.5x106 MSC or vehicle intravenously twice after the first LPS instillation (acute study or in week 14, 16, 18 and 20 (chronic study. Inflammatory parameters were measured in bronchoalveolar lavage (BAL and lung tissue. Emphysema, pulmonary inflammation and atherosclerosis were assessed in the chronic study.In the acute study, intranasal LPS administration induced a marked systemic IL-6 response on day 3, which was inhibited after MSC treatment. Furthermore, MSC treatment reduced LPS-induced total cell count in BAL due to reduced neutrophil numbers. In the chronic study, LPS increased emphysema but did not aggravate atherosclerosis. Emphysema and atherosclerosis development were unaffected after MSC treatment.These data show that MSC inhibit LPS-induced pulmonary and systemic inflammation in the acute study, whereas MSC treatment had no effect on inflammation, emphysema and atherosclerosis development in the chronic study.

  17. Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening.

    Science.gov (United States)

    Triplette, Matthew; Sigel, Keith M; Morris, Alison; Shahrir, Shahida; Wisnivesky, Juan P; Kong, Chung Y; Diaz, Phillip T; Petraglia, Alycia; Crothers, Kristina

    2017-07-31

    Lung cancer screening may benefit HIV-infected (HIV) smokers because of an elevated risk of lung cancer, but may have unique harms because of HIV-specific risk factors for false-positive screens. This study seeks to understand whether inflammatory biomarkers and markers of chronic lung disease are associated with noncalcified nodules at least 4 mm (NCN) in HIV compared with uninfected patients. This is a cohort study of Examinations of HIV-Associated Lung Emphysema (EXHALE), including 158 HIV and 133 HIV-uninfected participants. Participants underwent a laboratory assessment [including measurement of D-dimer, interleukin 6, and soluble CD14 (sCD14)], chest computed tomography (CT), and pulmonary function testing. We created multivariable logistic regression models to determine predictors of NCN in the participants stratified by HIV status, with attention to semiqualitative scoring of radiographic emphysema, markers of pulmonary function, and inflammatory biomarkers. Of the 291 participants, 69 had NCN on chest CT. As previously reported, there was no difference in prevalence of these nodules by HIV status. Emphysema and elevated sCD14 demonstrated an association with NCN in HIV participants independent of smoking status, CD4 cell count, HIV viral load, and pulmonary function. Emphysema and sCD14, a marker of immune activation, was associated with a higher prevalence of NCN on chest CT in HIV participants. Patients with chronic immune activation and emphysema may be at higher risk for both false-positive findings and incident lung cancer, thus screening in this group requires further study to understand the balance of benefits and harms.

  18. Acute and chronic effects of treatment with mesenchymal stromal cells on LPS-induced pulmonary inflammation, emphysema and atherosclerosis development.

    Science.gov (United States)

    Khedoe, P Padmini S J; de Kleijn, Stan; van Oeveren-Rietdijk, Annemarie M; Plomp, Jaap J; de Boer, Hetty C; van Pel, Melissa; Rensen, Patrick C N; Berbée, Jimmy F P; Hiemstra, Pieter S

    2017-01-01

    COPD is a pulmonary disorder often accompanied by cardiovascular disease (CVD), and current treatment of this comorbidity is suboptimal. Systemic inflammation in COPD triggered by smoke and microbial exposure is suggested to link COPD and CVD. Mesenchymal stromal cells (MSC) possess anti-inflammatory capacities and MSC treatment is considered an attractive treatment option for various chronic inflammatory diseases. Therefore, we investigated the immunomodulatory properties of MSC in an acute and chronic model of lipopolysaccharide (LPS)-induced inflammation, emphysema and atherosclerosis development in APOE*3-Leiden (E3L) mice. Hyperlipidemic E3L mice were intranasally instilled with 10 μg LPS or vehicle twice in an acute 4-day study, or twice weekly during 20 weeks Western-type diet feeding in a chronic study. Mice received 0.5x106 MSC or vehicle intravenously twice after the first LPS instillation (acute study) or in week 14, 16, 18 and 20 (chronic study). Inflammatory parameters were measured in bronchoalveolar lavage (BAL) and lung tissue. Emphysema, pulmonary inflammation and atherosclerosis were assessed in the chronic study. In the acute study, intranasal LPS administration induced a marked systemic IL-6 response on day 3, which was inhibited after MSC treatment. Furthermore, MSC treatment reduced LPS-induced total cell count in BAL due to reduced neutrophil numbers. In the chronic study, LPS increased emphysema but did not aggravate atherosclerosis. Emphysema and atherosclerosis development were unaffected after MSC treatment. These data show that MSC inhibit LPS-induced pulmonary and systemic inflammation in the acute study, whereas MSC treatment had no effect on inflammation, emphysema and atherosclerosis development in the chronic study.

  19. Coal Mine Dust Desquamative Chronic Interstitial Pneumonia: A Precursor of Dust-Related Diffuse Fibrosis and of Emphysema.

    Science.gov (United States)

    Jelic, Tomislav M; Estalilla, Oscar C; Sawyer-Kaplan, Phyllis R; Plata, Milton J; Powers, Jeremy T; Emmett, Mary; Kuenstner, John T

    2017-07-01

    Diseases associated with coal mine dust continue to affect coal miners. Elucidation of initial pathological changes as a precursor of coal dust-related diffuse fibrosis and emphysema, may have a role in treatment and prevention. To identify the precursor of dust-related diffuse fibrosis and emphysema. Birefringent silica/silicate particles were counted by standard microscope under polarized light in the alveolar macrophages and fibrous tissue in 25 consecutive autopsy cases of complicated coal worker's pneumoconiosis and in 21 patients with tobacco-related respiratory bronchiolitis. Coal miners had 331 birefringent particles/high power field while smokers had 4 (pcoal miner had intra-alveolar macrophages with silica/silicate particles and interstitial fibrosis ranging from minimal to extreme. All coal miners, including those who never smoked, had emphysema. Fibrotic septa of centrilobular emphysema contained numerous silica/silicate particles while only a few were present in adjacent normal lung tissue. In coal miners who smoked, tobacco-associated interstitial fibrosis was replaced by fibrosis caused by silica/silicate particles. The presence of silica/silicate particles and anthracotic pigment-laden macrophages inside the alveoli with various degrees of interstitial fibrosis indicated a new disease: coal mine dust desquamative chronic interstitial pneumonia, a precursor of both dust-related diffuse fibrosis and emphysema. In studied coal miners, fibrosis caused by smoking is insignificant in comparison with fibrosis caused by silica/silicate particles. Counting birefringent particles in the macrophages from bronchioalveolar lavage may help detect coal mine dust desquamative chronic interstitial pneumonia, and may initiate early therapy and preventive measures.

  20. Subcutaneous Implants of Buprenorphine-Cholesterol-Triglyceride Powder in Mice

    OpenAIRE

    L. DeTolla; R. Sanchez; E. Khan; B. Tyler; M. Guarnieri

    2014-01-01

    Subcutaneous drug implants are convenient systems for the long-term delivery of drugs in animals. Lipid carriers are logical tools because they generally allow for higher doses and low toxicity. The present study used an US Food and Drug Administration Target Animal Safety test system to evaluate the safety of a subcutaneous implant of a cholesterol-triglyceride-buprenorphine powder in 120 BALB/c mice. Mice were evaluated in 4- and 12-day trials with 1- and 5-fold doses of the intended 3 mg/k...

  1. Anisotropic bioelectrical impedance determination of subcutaneous fat thickness

    Science.gov (United States)

    Hernández-Becerra, P. A. I.; Delgadillo-Holtfort, I.; Balleza-Ordaz, M.; Huerta-Franco, M. R.; Vargas-Luna, M.

    2014-11-01

    Preliminary results have shown that bioelectrical impedance measurements performed on different parts of the human body strongly depend upon the subcutaneous fat of the considered region. In this work, a method for the determination of subcutaneous fat thickness is explored. Within this method the measurement of the bioelectrical impedance response of the fat-muscle system, both along the direction defined by the muscle fibers and along the corresponding perpendicular direction, are performed. Measurements have been carried out on human female and male subjects of ages around 25 years old at the region of the biceps. Correlation has been performed with skinfold caliper measurements.

  2. Unicentric study of cell therapy in chronic obstructive pulmonary disease/pulmonary emphysema

    Directory of Open Access Journals (Sweden)

    João Tadeu Ribeiro-Paes

    2011-01-01

    Full Text Available João Tadeu Ribeiro-Paes1, Aldemir Bilaqui2, Oswaldo T Greco2, Milton Artur Ruiz2, Monica Y Marcelino3, Talita Stessuk1, Carolina A de Faria3, Mario R Lago21Universidade Estadual Paulista (UNESP, Campus de Assis, Assis, SP, Brazil; 2Cardiovascular Diseases Institute (IMC, São José do Rio Preto, SP, Brazil; 3Inter-units Biotechnology Post Graduation Program, USP-IPT-I, Butantan, São Paulo, SP, BrazilAbstract: Within the chronic obstructive pulmonary disease (COPD spectrum, lung emphysema presents, as a primarily histopathologic feature, the destruction of pulmonary parenchyma and, accordingly, an increase in the airflow obstruction distal to the terminal bronchiole. Notwithstanding the significant advances in prevention and treatment of symptoms, no effective or curative therapy has been accomplished. In this context, cellular therapy with stem cells (SCs arises as a new therapeutic approach, with a wide application potential. The purpose of this study is to evaluate the safety of SCs infusion procedure in patients with advanced COPD (stage IV dyspnea. After selection, patients underwent clinical examination and received granulocyte colony-stimulating factor, immediately prior to the bone marrow harvest. The bone marrow mononuclear cells (BMMC were isolated and infused into a peripheral vein. The 12-month follow-up showed a significant improvement in the quality of life, as well as a clinical stable condition, which suggest a change in the natural process of the disease. Therefore, the proposed methodology in this study for BMMC cell therapy in sufferers of advanced COPD was demonstrated to be free of significant adverse effects. Although a larger sample and a greater follow-up period are needed, it is possible to infer that BMMC cell therapy introduces an unprecedented change in the course or in the natural history of emphysema, inhibiting or slowing the progression of disease. This clinical trial was registered with ClinicalTrials.gov (NCT

  3. SU-G-206-15: Effects of Dose Reduction On Emphysema Score

    Energy Technology Data Exchange (ETDEWEB)

    Lo, P; Wahi-Anwar, M; Kim, H [University of California, Los Angeles, Los Angeles, CA (United States); Young, S; Hoffman, J [UCLA, Los Angeles, CA (United States); McNitt-Gray, M [UCLA School of Medicine, Los Angeles, CA (United States)

    2016-06-15

    Purpose: The purpose of this study was to investigate the effects of reducing radiation dose levels on emphysema scores from lung cancer screening CT exams. Methods: 52 cases were selected from the National Lung Screening Trial (NLST) patients for which we had both the image series and the raw CT data. All scans were acquired with fixed effective mAs (25 for standard-sized patients, 40 for large patients) on a 64-slice scanner (Sensation 64, Siemens Healthcare) using 120kV, 64×0.6mm collimation and pitch 1.0. All images were reconstructed with 1mm slice thickness, B50 kernel. Based on a previously-published technique, we added noise to the raw data to simulate reduced-dose versions at 50% and 25% of the original dose (approximately 1.0- and 0.5-mGy CTDIvol). Lung segmentations were obtained via region growing from manual seed point at a threshold of 600HU followed by manual removal of trachea and major airways. Lung segmentations were only performed on original dose scans, and mapped to simulated reduced-dose scans. Emphysema scores based on relative area of lung with attenuation values lower than −950HU (RA950) were computed for all cases. Results: Average RA950 of all 50 cases were 31.6 (±5.5), 32.5 (±4.9) and 32.8 (±4.6) for 100%, 50% and 25% dose level respectively. The average absolute difference in RA950 between simulated and original dose scans were 1.0 (±0.7) and 1.4 (±1.1) for 50% and 25% dose level respectively. Conclusion: RA950 is relatively robust to dose level, with a difference of no more than 5 from the original dose scans. The average RA950 of this population was high for a two reasons: This was a high risk population of patients with substantial smoking history; The use of B50 kernel, which may be biased towards high emphysema scores. Further exploration with smoother kernels will be conducted in the future. Institutional research agreement, Siemens Healthcare; Past recipient, research grant support, Siemens Healthcare; Consultant, Toshiba

  4. Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality

    Directory of Open Access Journals (Sweden)

    Kravchenko J

    2014-06-01

    Full Text Available Julia Kravchenko,1 Igor Akushevich,2 Amy P Abernethy,3 Sheila Holman,4 William G Ross Jr,5 H Kim Lyerly1,6 1Department of Surgery, 2Center for Population Health and Aging, 3Duke Clinical Research Institute, Duke University Medical Center, Duke University, Durham, 4Division of Air Quality, North Carolina Department of Environment and Natural Resources, Raleigh, 5Nicholas School of the Environment, 6Department of Pathology, Duke University Medical Center, Duke University, Durham, NC, USA Background: The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations. Materials and methods: We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2, nitrogen dioxide (NO2, carbon monoxide (CO, and particulate matters (PM2.5 and PM10 using monthly data measurements from air-monitoring stations in North Carolina in 1993–2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths. Results: Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths–with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths–with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only

  5. An experimental study on tissue damage following subcutaneous injection of water soluble contrast media

    International Nuclear Information System (INIS)

    Kim, Seung Hyup; Park, Jae Hyung; Kang, Heung Sik; Kim, Chu Wan; Han, Man Chung; Kim, Yong Il

    1989-01-01

    The water soluble contrast media cause tissue necrosis infrequently by extravasation during intravenous injection in various radiological examinations. However, it has not been well documented that what kind and what concentration of contrast media can cause tissue necrosis. And also, the mechanism of tissue necrosis by extravasated contrast media has not been well known. The purpose of this experimental study was to evaluate the frequency and severity of tissue damage following subcutaneous injection of various water soluble contrast media to investigate the characteristics of the contrast media acting on the tissue damage, and to provide the basic data for the clinical application. Meglumine ioxithalamate,sodium and meglumine ioxithalamate, iopromide, iopamidol, ioxaglate,meglumine diatrizoate and sodium diatrizoate of various iodine content and osmolality were injected into subcutaneous tissue of the dorsum of 970 feet of 485 rats. The tissue reaction of injection sites were grossly examined with period from 1 day to 8 weeks after the injection. Representative gross changes were correlated with histologic findings. The results were as follows; 1. The basic tissue damage by extravasated contrast media was acute and chronic inflammatory reaction of the soft tissue with subsequent progress into the hemorrhagic and necrotizing lesion. 2. Lager volume of contrast media caused more severe tissue damage. 3. Contrast media of higher osmolality caused more severe tissue damage. 4. At same osmolality, contrast media of higher iodine content caused more severe tissue damage

  6. Population Pharmacokinetic and Pharmacodynamic Analysis of Belimumab Administered Subcutaneously in Healthy Volunteers and Patients with Systemic Lupus Erythematosus.

    Science.gov (United States)

    Struemper, Herbert; Thapar, Mita; Roth, David

    2017-09-08

    Intravenous belimumab 10 mg/kg every 4 weeks is indicated in patients with active, autoantibody-positive systemic lupus erythematosus receiving standard systemic lupus erythematosus care. Subcutaneous 200-mg weekly administration, which may prove more convenient for patients and improve adherence, is currently under investigation. The objective of this study was to characterize the population pharmacokinetics and exposure-efficacy response of subcutaneous belimumab in a pooled analysis of pharmacokinetic data [phase I: BEL114448 (NCT01583530) and BEL116119 (NCT01516450) in healthy subjects (n = 134); phase III: BEL112341 (NCT01484496) in adults with systemic lupus erythematosus (n = 554)] and pharmacodynamic data [BEL112341 in adults with systemic lupus erythematosus (n = 833)]. Non-linear mixed-effects modeling (NONMEM®) was used to develop a population pharmacokinetic model and perform a covariate analysis. Subsequently, exploratory exposure-response analysis and logistic regression modeling was performed based on the individual parameter estimates of the population pharmacokinetic model. Population-pharmacokinetic parameters for subcutaneous belimumab were consistent with those for intravenous belimumab and other immunoglobulin G1 monoclonal antibodies. Pharmacokinetic parameters and subcutaneous belimumab exposure were consistent between healthy subjects and patients with systemic lupus erythematosus, and no evidence for target-mediated disposition of belimumab was found. Subcutaneous belimumab steady-state exposure was achieved after ~11 weeks; subcutaneous belimumab steady-state minimum concentration exceeded that of intravenous belimumab after <4 weeks, and average steady-state concentration was similar to that achieved following intravenous administration. In patients with moderate-to-severe systemic lupus erythematosus, subcutaneous belimumab 200 mg once weekly plus standard of care significantly improved the systemic lupus erythematosus

  7. Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking

    DEFF Research Database (Denmark)

    Grydeland, T B; Dirksen, A; Coxson, H O

    2009-01-01

    We investigated how quantitative high-resolution computed tomography (HRCT) measures of emphysema and airway wall thickness (AWT) vary with sex, age and smoking history. We included 463 chronic obstructive pulmonary disease (COPD) cases and 431 controls. All included subjects were current or ex......-smokers aged > or = 40 yrs, and all underwent spirometry and HRCT examination. The HRCT images were quantitatively assessed, providing indices on lung density and airway dimensions. The median (25-75th percentile) %LAA950 (% low-attenuation area ... cases, respectively, and 0.71 (0.3-1.6) and 0.32 (0.1-0.8) in male and female controls, respectively. %LAA950 was higher in ex-smokers and increased with increasing age and with increasing number of pack-years. The mean+/-SD standardised AWT was 0.504+/-0.030 and 0.474+/-0.031 in male and female COPD...

  8. Characterization of outcomes 1 year after endoscopic thermal vapor ablation for patients with heterogeneous emphysema

    Directory of Open Access Journals (Sweden)

    Herth FJ

    2012-07-01

    Full Text Available Felix JF Herth,1 Armin Ernst,2 Kimberly M Baker,3 Jim J Egan,4 Mark H Gotfried,5 Peter Hopkins,6 Franz Stanzel,7 Arschang Valipour,8 Manfred Wagner,9 Christian Witt,10 Steven Kesten,11 Gregory Snell121Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany; 2St Elizabeth's Medical Center, Boston, MA, USA; 3University of Iowa, Iowa City, IA, USA; 4Advanced Lung Disease Program, Mater Misericordiae University Hospital, Dublin, Ireland; 5Pulmonary Associates, Phoenix, AZ, USA; 6Lung Transplant Unit, Prince Charles Hospital, Chermside, Australia; 7Zentrum für Pneumologie, Hemer, Germany; 8Ludwig-Boltzmann-Institute for COPD, Otto-Wagner-Hospital, Vienna, Austria; 9Klinikum Nürnberg, Nürnberg, Germany; 10Pneumology, Charité Campus-Mitte, Berlin, Germany; 11Uptake Medical Corp, Tustin, CA, USA; 12Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, AustraliaIntroduction: Endoscopic lung volume reduction has been developed as a therapeutic option for advanced emphysema. Six-month results following treatment with endoscopic thermal vapor ablation (InterVapor™; Uptake Medical, Tustin, CA were described previously, and here we report observations from the 12-month assessment.Methods: Two multicenter, international, single-arm trials of InterVapor (unilateral upper lobe treatment in patients with upper lobe predominant emphysema were conducted. Inclusion criteria: forced expiratory volume in 1 second (FEV1 15%–45% predicted, residual volume > 150%, total lung capacity > 100%, 6-minute walk distance (6MWD > 140 m, and diffusing capacity for carbon monoxide > 20% predicted. Efficacy endpoints: spirometry, body plethysmography, lung volumes by high-resolution computed tomography, St George's Respiratory Questionnaire, modified Medical Research Council dyspnea scale, and 6MWD. All adverse events were collected and independently adjudicated.Results: Forty four patients were treated at a mean (standard

  9. Worldwide experience with a totally subcutaneous implantable defibrillator

    DEFF Research Database (Denmark)

    Lambiase, Pier D; Barr, Craig; Theuns, Dominic A M J

    2014-01-01

    AIMS: The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large international...

  10. Spatial distribution of soluble insulin in pig subcutaneous tissue

    DEFF Research Database (Denmark)

    Thomsen, Maria; Rasmussen, Christian Hove; Refsgaard, Hanne H F

    2015-01-01

    injections. Increasing the injected volume from 0.1ml to 1ml did not increase the intramuscular volume fraction, but gave a significantly higher volume fraction placed in the fascia separating the deep and superficial subcutaneous fat layers. Varying the injection speed from 25l/s up to 300l/s gave...

  11. Symptomatic Tarlov Cysts: Surgical Treatment by Subcutaneous Infusion Port.

    Science.gov (United States)

    Huang, Ying; Zhu, Tong; Lin, Hongyi; Li, Jing; Zeng, Tao; Lin, Jian

    2018-05-01

    The treatment of Tarlov cysts is challenging and difficult. The objective of our study was to describe the security and efficacy of the subcutaneous infusion port for drainage of symptomatic Tarlov cysts. The authors executed a retrospective review of data from 5 symptomatic Tarlov cysts patients who were treated using a subcutaneous infusion port from June 2014 to July 2017. Numerical Rating Scale scores and the Japanese Orthopedic Association scores of back pain were analyzed. Complications and adverse effects on postoperative days 1, 7, 14, and 28 were also analyzed. The mean follow-up was 12.6 months. Five adults (3 females and 2 males) who had been symptomatic received a subcutaneous infusion port. After treatment, all patients experienced pain relief and pain alleviation lasted from 1 day to 3 years without complications and adverse effects. A subcutaneous infusion port is a useful treatment option for symptomatic Tarlov cysts. When the patients' symptoms returned and the cysts repressurized, we quickly and simply drained the cysts by using the infusion port. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Reversible Crystallization of Argatroban after Subcutaneous Application in Pigs

    Directory of Open Access Journals (Sweden)

    Mercedes Lopez

    2012-01-01

    Full Text Available Argatroban is a thrombin inhibitor used as anticoagulant in patients with heparin-induced thrombocytopenia. It is usually administered as an intravenous bolus followed by infusion. Nevertheless, its pharmacokinetics after subcutaneous administration is unknown. The aim of this study was to assess the pharmacokinetics of two different formulations of argatroban in pigs after subcutaneous administration. Antithrombotic activity in plasma was determined by ecarin chromogenic assay. To visualize the formation of crystals, argatroban was administered to rats into the subcutaneous tissue exposed after removing the skin, and the injection site was photographed at different times. After subcutaneous administration of a sorbitol/ethanol formulation of argatroban in pigs was observed a slow absorption phase was followed by long-lasting levels of this inhibitor. Cmax and AUC(0-24 showed dose-dependent increases, while elimination half-life and tmax value did not change significantly with dose. In contrast, saline-dissolved argatroban showed a faster absorption phase followed by a shorter elimination half-life. Argatroban dissolved in sorbitol/ethanol leads to long-lasting plasma levels due to the formation and permanent dissolution of a crystalline depot at the injection place. This represents a simple way to deliver argatroban continuously over an extended period which can be beneficial for prophylaxis or treatment of chronic coagulations disorders.

  13. SUBCUTANEOUS PERONEUS LONGUS TENDON RUPTURE ASSOCIATED WITH OS PERONEUM FRACTURE

    Directory of Open Access Journals (Sweden)

    Shinichi Yoshiya

    2009-12-01

    Full Text Available We report a rare case of subcutaneous peroneus longus tendon rupture associated with os peroneum fracture. Three dimensional computed tomographic scan was useful to understand this disorder. We treated the patient with excision of fractured os peroneum and tenodesis of the proximal stump of the ruptured peroneus longus tendon to the lateral aspect of the calcaneus

  14. Early clinical experience with subcutaneous GR43175 in acute migraine

    DEFF Research Database (Denmark)

    Tfelt-Hansen, P; Brand, J; Dano, P

    1989-01-01

    In six European clinics 111 migraine patients were treated in a series of open dose-ranging studies with subcutaneous injections of 1 to 4 mg GR43175, a novel 5-HT 1-like receptor agonist. Response rates after 20-30 min were dose related and rose from 33% with 1 mg to 96% with 4 mg GR43175. Side ...

  15. Subcutaneous Implantable Cardioverter Defibrillator Lead Failure due to Twiddler Syndrome

    NARCIS (Netherlands)

    Kooiman, Kirsten M.; Brouwer, Tom F.; van Halm, Vokko P.; Knops, Reinoud E.

    2015-01-01

    We present a case of Twiddler syndrome in a patient with a subcutaneous implantable cardioverter defibrillator (S-ICD). The patient presented herself to the outpatient clinic with pain in the left chest. Chest x-ray confirmed Twiddler syndrome and ICD read-out revealed lead failure resulting in

  16. Subcutaneous Phaeohyphomycosis Caused by Wallemia sebi in an Immunocompetent Host▿

    Science.gov (United States)

    Guarro, Josep; Gugnani, Harish C.; Sood, Neelam; Batra, Rashmi; Mayayo, Emilio; Gené, Josepa; Kakkar, Shalini

    2008-01-01

    We report a case of subcutaneous phaeohyphomycosis due to Wallemia sebi in a 43-year-old-female, the first case reported since 1950. The lesion presented as a nonhealing ulcer on the dorsum of the left foot. Diagnosis was based on histological demonstration of the fungus and its recovery in culture. PMID:18174296

  17. Subcutaneous phaeohyphomycosis caused by Wallemia sebi in an immunocompetent host.

    Science.gov (United States)

    Guarro, Josep; Gugnani, Harish C; Sood, Neelam; Batra, Rashmi; Mayayo, Emilio; Gené, Josepa; Kakkar, Shalini

    2008-03-01

    We report a case of subcutaneous phaeohyphomycosis due to Wallemia sebi in a 43-year-old-female, the first case reported since 1950. The lesion presented as a nonhealing ulcer on the dorsum of the left foot. Diagnosis was based on histological demonstration of the fungus and its recovery in culture.

  18. Microcosting Study of Rituximab Subcutaneous Injection Versus Intravenous Infusion

    NARCIS (Netherlands)

    Mihajloviç, Jovan; Bax, Pieter; van Breugel, Erwin; Blommestein, Hedwig M.; Hoogendoorn, Mels; Hospes, Wobbe; Postma, Maarten J.

    Purpose: The goal of this study is to identify and compare all direct costs of intravenous and subcutaneous rituximab given to patients with diffuse large B-cell lymphoma in the Netherlands.  Methods: Using a prospective, observational, bottom-up microcosting study, we collected primary data on the

  19. Efficacy and tolerability of 16% subcutaneous immunoglobulin compared with 20% subcutaneous immunoglobulin in primary antibody deficiency.

    Science.gov (United States)

    Niebur, H B; Duff, C M; Shear, G F; Nguyen, D; Alberdi, T K; Dorsey, M J; Sleasman, J W

    2015-09-01

    Multiple subcutaneous immunoglobulin (SCIG) products are available to treat primary antibody deficiency (PAD). The efficacy and tolerability of 16% SCIG (Vivaglobin(®) ) was compared with 20% SCIG (Hizentra(®) ) in PAD subjects. The study was a prospective, single-centre, open-label study of PAD subjects transitioning Vivaglobin to equivalent Hizentra doses, rounded to the nearest vial size. Comparisons included immunoglobulin (Ig)G levels; tetanus, varicella and Streptococcus pneumoniae titres; adverse events (AEs), annual infection rate and quality of life during 8 weeks of Vivaglobin and 24 weeks of Hizentra. Thirty-two subjects (aged 2-75 years) participated. Rounding to the nearest Hizentra vial size resulted in a 12·8% (± 2·9%) increase in SCIG dose. Median immunoglobulin (Ig)G level following 8 weeks of Vivaglobin was similar to 24 weeks of Hizentra (1050 versus 1035 mg/dl, respectively; P = 0·77). Both products had similar protective titres to tetanus, varicella and serotypes of S. pneumoniae, which were variable but well above protective levels. After 12 weeks of Hizentra, subjects reported fewer local site reactions compared with Vivaglobin. Switching products resulted in increased systemic AEs in some subjects but, overall, not significantly higher than during Vivaglobin treatment. Average infusion time decreased from 104·7 min (3·3 sites) with Vivaglobin to 70·7 min (2·2 sites) with Hizentra (P = 0·0005). Acute serious bacterial infections were similar. Treatment satisfaction was superior with Hizentra. Hizentra and Vivaglobin have similar pharmacokinetics and efficacy. Although transition to a different SCIG product initially increased AEs, Hizentra is well tolerated and can be infused more rapidly and with fewer sites compared to Vivaglobin. © 2015 British Society for Immunology.

  20. MECHANISMS OF COUNTERACTING FLAP-VALVE BRONCHIAL OBSTRUCTION IN CASE OF OBSTRUCTIVE PULMONARY EMPHYSEMA

    Directory of Open Access Journals (Sweden)

    K. F. Tetenev

    2015-01-01

    Full Text Available The research goal was to formulate and substantiate the hypothesis explaining support for an expiratory air flow in case of pulmonary emphysema. The research method consisted in comparing the mechanical properties of lungs in practically healthy individuals (37 individuals, mean age – (30.4 ± 1.7 y.o. and COPD patients with pronounced lung emphysema (30 patients, mean age – (52.1 ± 2.3 y.o. as well as those of isolated normal lungs (n = 14 and isolated lungs of patients who died of COPD (n = 5. Pulmo-nary mechanics was studied via the simultaneous measurement of transpulmonary pressure and lung ven-tilation volume. General lung hysteresis and elastic lung hysteresis were calculated. The mechanical properties of isolated lungs were studied using passive ventilation under the Donders bell. The air flow was interrupted in order to measure alveolar pressure and develop an elastic lung hysteresis curve. Pres-sure in the Donders bell was changed by means of a special pump in automatic and manual modes. The research has not revealed any fundamental differences between the mechanical properties of the normal and emphysematous lungs. A minimum increase in the pressure inside the Donders bell over atmospheric pressure used to stop air ejection in both normal and the emphysematous lungs as the result of flap-valve bronchial obstruction. In living beings, air is ejected from lungs with an increase in pressure under the conditions of forced expiration. Pressure increases up to (38.6 ± 2.71 cm H2O in healthy individuals and up to (20.5 ± 1.86 cm H2O in COPD patients. Probably, an expiratory air flow is supported by active expiratory bronchial dilatation that counteracts flap-valve bronchial obstruction. The hypothesis is based on the confirmed ability of the lungs to perform inspiratory actions (in addition to the action of respiratory muscles and the theory of mechanical lung activity.