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2.
Ann R Coll Surg Engl ; 102(2): e26-e28, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31418283

RESUMO

Superior mesenteric artery syndrome, a rare cause of duodenal obstruction, occasionally requires surgery. Bowel emphysema might also require surgery and might be an ominous sign of a serious condition. We report the case of a 69-year-old Japanese man with left pneumothorax who was also diagnosed as having bowel emphysema and superior mesenteric artery syndrome simultaneously without serious infection after surgery for the pneumothorax. Following gastric decompression via a nasogastric tube, his general condition resolved quickly with no need for surgical intervention. Prompt and precise diagnosis by computed tomography and both adequate judgment and treatment can avoid surgery in such cases.


Assuntos
Enfisema/etiologia , Intubação Gastrointestinal , Enfisema Pulmonar/cirurgia , Síndrome da Artéria Mesentérica Superior/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Duodeno/diagnóstico por imagem , Enfisema/diagnóstico , Enfisema/terapia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Aerosp Med Hum Perform ; 90(10): 867-871, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558195

RESUMO

BACKGROUND: Preventive treatment for incidentally detected blebs or bullae is required for fast jet pilots, but their aeromedical risk is not clearly proven.METHODS: This is a retrospective study and includes 46 pilots 40 yr and older with incidentally detected emphysema-like changes (ELCs) comprising blebs or bullae in low-dose chest CT (LDCT) during health screening. Two radiologists retrospectively reviewed imaging features. Statistical analysis was done using independent t-tests and bivariate analysis.RESULTS: Among 46 pilots, 39 pilots flew fast jet aircraft and 7 pilots flew nonfast jet aircraft. The mean follow-up period was 1531 d and the LDCT follow-up interval mean period was 424.4 d. There was no evidence of rupture in incidentally detected ELCs during the follow-up period. The mean size of the ELCs was 19.15 mm. There were five cases showing changes in size. There was a statistically significant correlation between the size of ELCs and height. There were no statistically significant differences in the size or number of ELCs relating to smoking status or aircraft type, and there were no statistically significant correlations between the size or number of ELCs and multiple factors, including smoking quantity, flight time, age, BMI, and weight.CONCLUSION: This study demonstrates the aeromedical safety of incidentally detected ELCs in pilots 40 yr and older without underlying lung disease. The results indicate no need for recommending preventive treatment for ELCs in pilots 40 yr and older, even those flying fast jet aircraft, as a requisite to continue their flight duties. KEYWORDS: bleb, bulla, pilot, CT.Bang S, Yang S, Cho SW, Kim DH, Kang H. Follow-up of blebs and bullae in pilots 40 years and older using CT. Aerosp Med Hum Perform. 2019; 90(10):867-871.


Assuntos
Medicina Aeroespacial , Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Pneumotórax/epidemiologia , Enfisema Pulmonar/epidemiologia , Adulto , Aeronaves , Seguimentos , Humanos , Incidência , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Enfisema Pulmonar/complicações , Enfisema Pulmonar/terapia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Tomografia Computadorizada por Raios X
4.
Medicina (Kaunas) ; 55(9)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31509942

RESUMO

Combined pulmonary fibrosis and emphysema (CPFE) has been increasingly recognized over the past 10-15 years as a clinical entity characterized by rather severe imaging and gas exchange abnormalities, but often only mild impairment in spirometric and lung volume indices. In this review, we explore the gas exchange and mechanical pathophysiologic abnormalities of pulmonary emphysema, pulmonary fibrosis, and combined emphysema and fibrosis with the goal of understanding how individual pathophysiologic observations in emphysema and fibrosis alone may impact clinical observations on pulmonary function testing (PFT) patterns in patients with CPFE. Lung elastance and lung compliance in patients with CPFE are likely intermediate between those of patients with emphysema and fibrosis alone, suggesting a counter-balancing effect of each individual process. The outcome of combined emphysema and fibrosis results in higher lung volumes overall on PFTs compared to patients with pulmonary fibrosis alone, and the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio in CPFE patients is generally preserved despite the presence of emphysema on chest computed tomography (CT) imaging. Conversely, there appears to be an additive deleterious effect on gas exchange properties of the lungs, reflecting a loss of normally functioning alveolar capillary units and effective surface area available for gas exchange, and manifested by a uniformly observed severe reduction in the diffusing capacity for carbon monoxide (DLCO). Despite normal or only mildly impaired spirometric and lung volume indices, patients with CPFE are often severely functionally impaired with an overall rather poor prognosis. As chest CT imaging continues to be a frequent imaging modality in patients with cardiopulmonary disease, we expect that patients with a combination of pulmonary emphysema and pulmonary fibrosis will continue to be observed. Understanding the pathophysiology of this combined process and the abnormalities that manifest on PFT testing will likely be helpful to clinicians involved with the care of patients with CPFE.


Assuntos
Enfisema Pulmonar/complicações , Fibrose Pulmonar/complicações , Testes de Função Respiratória , Humanos , Enfisema Pulmonar/fisiopatologia , Fibrose Pulmonar/fisiopatologia
6.
Acta Vet Scand ; 61(1): 37, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349870

RESUMO

BACKGROUND: Pulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals. CASE PRESENTATION: A 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems. CONCLUSIONS: This case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.


Assuntos
Anormalidades Múltiplas/veterinária , Doenças do Cão/congênito , Pneumopatias/veterinária , Pulmão/anormalidades , Pneumotórax/veterinária , Enfisema Pulmonar/congênito , Animais , Cães , Pulmão/química , Pulmão/patologia , Pulmão/cirurgia , Pneumopatias/congênito , Masculino , Pneumotórax/etiologia , Pneumotórax/patologia , Pneumotórax/cirurgia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/veterinária , Resultado do Tratamento
7.
J Surg Res ; 243: 206-212, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31195349

RESUMO

BACKGROUND: Giant pulmonary bullae (GPB) is rare. The aim of this study was to evaluate the functional results of video-assisted thoracic surgery (VATS) in the treatment of GPB and the factors associated with complications following VATS resection for GPB. MATERIALS AND METHODS: From January 2010 to January 2015, 44 GPB patients underwent surgery with VATS. Individual GPB patient characteristics and surgical outcomes were evaluated. The patients were separated into two groups (an emphysematous group and a nonemphysematous group), and differences between the respective groups were investigated. RESULTS: Although there were no mortalities within a 30-d postoperative period among the 44 GPB patients treated surgically with VATS, 28 experienced postoperative complications, of which the most common were air leaks. VATS for GPB resulted in obvious improvements in symptoms and lung function in the majority of cases. Among 26 patients with preoperative dyspnea, the symptoms of 22 patients (84.62%) improved after treatment with VATS resection for GPB, and the mean forced expiratory volume in 1 s increased from 2.24 L preoperatively to 2.5 L postoperatively (P = 0.02). The complication rate of patients aged >48 y, who smoked and had emphysema, was significantly higher than that of those who did not smoke and did not have emphysema (79.2% versus 45%, P = 0.019; 85.7% versus 25%, P < 0.05; 88% versus 31.6%, P < 0.05). These characteristics could be associated with complications. CONCLUSIONS: VATS resection is a safe and effective treatment for GPB and leads to improvements in symptoms and lung function. Patients >48 y, who smoked and had emphysema, were more likely to experience postoperative complications. There could be a relationship between these characteristics and the patients' postoperative complications.


Assuntos
Vesícula/complicações , Pneumotórax/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Vesícula/cirurgia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/complicações , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
Rev Mal Respir ; 36(5): 638-642, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31202604

RESUMO

INTRODUCTION: Lung volume reduction can be effective in appropriately selected patients with severe emphysema and is associated with reduced breathlessness and improved survival. Spontaneous resolution of emphysematous bullae can also sometimes occur. CASE REPORT: We report a case of severe smoking-related emphysema in a 60-year-old patient, who presented in October 2013 with a right upper lobe acute community-acquired pneumonia on the background of previously undocumented emphysema. The patient improved following treatment with co-amoxiclav and serial radiology showed progressive cicatricial retraction. Nine months later there had been a major functional improvement characterized by a complete normalization of the patient's ventilatory parameters, specifically a 45% improvement in FEV1. In the literature, the average FEV1 improvement obtained by surgical or endoscopic lung volume reduction techniques does not exceed 28%. CONCLUSION: Rarely, emphysematous bullae resolve following infections. Further studies of the mechanisms involved in these natural regressions may be of interest in the development of new therapeutics.


Assuntos
Pneumonia Associada a Assistência à Saúde/complicações , Pneumonia Associada a Assistência à Saúde/patologia , Pulmão/patologia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/patologia , Doença Aguda , Broncoscopia/métodos , Volume Expiratório Forçado , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Pneumonectomia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/cirurgia , Testes de Função Respiratória , Fumantes
9.
Clin Respir J ; 13(8): 499-504, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172658

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE) events. A detailed understanding of which clinical features of COPD increase risk of VTE events is needed. OBJECTIVES: To investigate the association between features of COPD and risk of venous thromboembolism. METHODS: A retrospective observational clinical study was conducted on 551 consecutive COPD patients visiting the Department of Respiratory and Critical Care Medicine of Tianjin Chest Hospital between February 2014 and April 2018. Finally, 151 patients were eligible for inclusion. Of these, 29 patients had COPD with VTE and 121 patients had COPD without VTE. Patient informations regarding age, gender, BMI, smoking history, smoking status (package/year), COPD-related symptoms, lung function, number of acute exacerbations and imaging visual emphysema were gathered. RESULTS: Among the 29 VTE patients, 18 patients had PE and five had DVT, while 6 patients had simultaneous PE and DVT. There were statistically significant differences in GOLD grade, Imaging visual emphysema, and frequent acute exacerbations between the two groups. Multivariate logistic regression analysis showed that after adjustment for gender, age, BMI and smoking history, there were statistically significant for visible emphysema (OR = 3.54, 95% CI: 1.13-11.08; P = 0.03) and GOLD grade (OR = 1.77, 95% CI: 1.04-3.01; P = 0.035), but not for frequent acute exacerbations (OR = 1.65, 95% CI: 0.62-4.38; P = 0.31). CONCLUSIONS: Visual emphysema is an independent risk factor for VTE events and the risk of VTE in COPD patients increases with the degree of airway obstruction. However, there is no evidence of an association between exacerbation frequency and VTE events.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/diagnóstico por imagem , Fumar/efeitos adversos , Tromboembolia Venosa/etiologia , Idoso , China/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/complicações , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Tromboembolia Venosa/epidemiologia
10.
Dis Model Mech ; 12(5)2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31036697

RESUMO

Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome that predominantly affects male smokers or ex-smokers and it has a mortality rate of 55% and a median survival of 5 years. Pulmonary hypertension (PH) is a frequently fatal complication of CPFE. Despite this dismal prognosis, no curative therapies exist for patients with CPFE outside of lung transplantation and no therapies are recommended to treat PH. This highlights the need to develop novel treatment approaches for CPFE. Studies from our group have demonstrated that both adenosine and its receptor ADORA2B are elevated in chronic lung diseases. Activation of ADORA2B leads to elevated levels of hyaluronan synthases (HAS) and increased hyaluronan, a glycosaminoglycan that contributes to chronic lung injury. We hypothesize that ADORA2B and hyaluronan contribute to CPFE. Using isolated CPFE lung tissue, we characterized expression levels of ADORA2B and HAS. Next, using a unique mouse model of experimental lung injury that replicates features of CPFE, namely airspace enlargement, PH and fibrotic deposition, we investigated whether 4MU, a HAS inhibitor, was able to inhibit features of CPFE. Increased protein levels of ADORA2B and HAS3 were detected in CPFE and in our experimental model of CPFE. Treatment with 4MU was able to attenuate PH and fibrosis but not airspace enlargement. This was accompanied by a reduction of HAS3-positive macrophages. We have generated pre-clinical data demonstrating the capacity of 4MU, an FDA-approved drug, to attenuate features of CPFE in an experimental model of chronic lung injury.This article has an associated First Person interview with the first author of the paper.


Assuntos
Adenosina/efeitos adversos , Ácido Hialurônico/efeitos adversos , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/patologia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/patologia , Agonistas do Receptor A2 de Adenosina/farmacologia , Adenosina Desaminase/metabolismo , Animais , Linhagem Celular , Doença Crônica , Modelos Animais de Doenças , Matriz Extracelular/metabolismo , Humanos , Hialuronan Sintases/metabolismo , Lesão Pulmonar/complicações , Lesão Pulmonar/patologia , Macrófagos/metabolismo , Camundongos , Receptor A2B de Adenosina/metabolismo
11.
BMC Pulm Med ; 19(1): 73, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947705

RESUMO

BACKGROUND: The presence of emphysema on computed tomography (CT) is associated with an increased frequency of lung cancer, but the postoperative outcomes of patients with pulmonary emphysema are not well known. The objective of this study was to investigate the association between the extent of emphysema and long-term outcomes, as well as mortality and postoperative complications, in early-stage lung cancer patients after pulmonary resection. METHODS: The clinical records of 566 consecutive lung cancer patients who underwent pulmonary resection in our department were retrospectively reviewed. Among these, the data sets of 364 pathological stage I patients were available. The associations between the extent of lung emphysema and long-term outcomes and postoperative complications were investigated. Emphysema was assessed on the basis of semiquantitative CT. Surgery-related complications of Grade ≥ II according to the Clavien-Dindo classification were included in this study. RESULTS: Emphysema was present in 63 patients. The overall survival and relapse-free survival of the non-emphysema and emphysema groups at 5 years were 89.0 and 61.3% (P < 0.001), respectively, and 81.0 and 51.7%, respectively (P < 0.001). On multivariate analysis, significant prognostic factors were emphysema, higher smoking index, and higher histologic grade (p < 0.05). Significant risk factors for poor recurrence-free survival were emphysema, higher smoking index, higher histologic grade, and presence of pleural invasion (P < 0.05). Regarding Grade ≥ II postoperative complications, pneumonia and supraventricular tachycardia were more frequent in the emphysema group than in the non-emphysema group (P = 0.003 and P = 0.021, respectively). CONCLUSION: The presence of emphysema affects the long-term outcomes and the development of postoperative complications in early-stage lung cancer patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Enfisema Pulmonar/complicações , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , Humanos , Japão/epidemiologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pneumonectomia/mortalidade , Prognóstico , Enfisema Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Histopathology ; 74(7): 1103-1108, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30715748

RESUMO

AIMS: Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome that results from tobacco smoking. Emphysema and fibrosis in CPFE patients have been considered to exist separately, with emphysema in the upper lobes and interstitial pneumonia in the lower lobes. The aim of this study was to examine the intrapulmonary distribution of fibrosis and emphysema in clinically diagnosed patients with idiopathic pulmonary fibrosis (IPF) and coexisting emphysema. METHODS AND RESULTS: Among IPF patients (n = 40) who had been autopsied or pneumonectomised for lung transplantation from 1993 to 2018, we retrospectively selected patients with IPF and coexisting emphysema (n = 19) on the basis of the appearance on chest computed tomography (IPF patients with emphysema). We then histologically determined the intrapulmonary distribution of emphysema and fibrosis in the upper lobes and the lower lobes separately. In 15 of the 19 IPF patients with emphysema (79%), fibrosis and emphysema coexisted in the upper lobes and the lower lobes. No patients showed emphysema exclusively in the upper lobes and fibrosis exclusively in the lower lobes. CONCLUSIONS: In the autopsied and pneumonectomised specimens of IPF patients with emphysema, craniocaudal separation of emphysema and fibrosis (emphysema in the upper lobes and interstitial pneumonia in the lower lobes) was histologically rare; coexistence or collision of fibrosis and emphysema in each lobe was common.


Assuntos
Fibrose Pulmonar Idiopática/patologia , Enfisema Pulmonar/patologia , Fumar Tabaco/patologia , Autopsia , Humanos , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pulmão/patologia , Transplante de Pulmão , Registros Médicos , Pneumonectomia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fumar Tabaco/efeitos adversos , Tomografia Computadorizada por Raios X
13.
J Bronchology Interv Pulmonol ; 26(2): 90-95, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30640825

RESUMO

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) coil treatment is an increasingly used treatment modality for selected severe emphysema patients in recent years. Emphysema causes dynamic hyperinflation, loss of elastic recoil, air trapping, and decreased exercise capacity in advanced stages. This process progresses over time, leading to hypoxic and hypercapnic respiratory failure. The goal of this study is to elucidate the effects of BLVR coil treatment on arterial blood gas parameters in severe emphysema patients with respiratory failure. METHODS: This is a retrospective study performed at a single pneumology center in Turkey. In total, this study included 39 patients diagnosed with severe emphysema who underwent bilateral BLVR coil treatment according to the general inclusion and exclusion criteria in the literature. The patients baseline and 12-month data were collected from medical records. RESULTS: Twelve months after BLVR coil treatment, significant improvements were observed in patients' pulmonary function tests, an increase in partial pressure of oxygen in arterial blood (PaO2) from 58.05±9.36 to 73.82±13.3 (P<0.000) and decrease in partial pressure of carbon dioxide in arterial blood (PaCO2) of hypercapnic patients (from 51.60±4.1 to 46.55±6.6 mm Hg; P=0.001). CONCLUSION: BLVR coil treatment is reliable and effective in emphysema patients who have hypoxic or mild hypercapnic respiratory failure. Besides improving lung function, BLVR coil treatment can significantly increase PaO2 and decrease PaCO2 in the medium term.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Gasometria , Dióxido de Carbono/sangue , Feminino , Humanos , Hipercapnia/sangue , Hipercapnia/etiologia , Hipóxia/sangue , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Enfisema Pulmonar/sangue , Enfisema Pulmonar/complicações , Insuficiência Respiratória/sangue , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Turquia
14.
Clin Respir J ; 13(4): 195-201, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615303

RESUMO

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.


Assuntos
Pneumotórax/fisiopatologia , Pneumotórax/terapia , Fumar/efeitos adversos , Vesícula/complicações , Bronquiolite/complicações , Tubos Torácicos/efeitos adversos , Gerenciamento Clínico , Humanos , Masculino , Agulhas/efeitos adversos , Paracentese/métodos , Pleura/anatomia & histologia , Pleurodese/métodos , Pneumotórax/epidemiologia , Guias de Prática Clínica como Assunto , Enfisema Pulmonar/complicações , Recidiva , Fatores de Risco , Talco/administração & dosagem , Talco/uso terapêutico , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos
15.
Bone ; 120: 114-124, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30342225

RESUMO

Although it is suggested that chronic obstructive pulmonary disease (COPD) and bone are related, almost all of the pathological mechanisms of COPD-related osteoporosis remain unknown. There is a mouse model showing a deterioration of bone quality after cigarette smoke exposure; however, in smoking exposure models, various factors exist that affect bone metabolism, such as smoking and body weight loss (muscle and fat mass loss). We considered it appropriate to use an elastase-induced emphysema model to exclude factors influencing bone metabolism and to investigate the influence of pulmonary emphysema on bone metabolism. The purpose of this study was to establish a COPD/emphysema-related osteoporosis mouse model by using the elastase-induced emphysema model. The lumbar vertebrae and femurs/tibiae exhibited trabecular bone loss and impaired osteogenic activity in 24-week-old male elastase-induced emphysema model mice. In addition, the model mice showed atrophy of type I muscle fibers without atrophy of type II muscle fibers. We believe that the mice described in this experimental protocol will be accepted as a COPD/emphysema-related osteoporosis mouse model and contribute to further investigations.


Assuntos
Reabsorção Óssea/complicações , Fibras Musculares Esqueléticas/patologia , Osteogênese , Osteoporose/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/induzido quimicamente , Enfisema Pulmonar/complicações , Animais , Atrofia , Biomarcadores/metabolismo , Peso Corporal , Densidade Óssea , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Modelos Animais de Doenças , Pulmão/patologia , Masculino , Camundongos Endogâmicos C57BL , Tamanho do Órgão , Elastase Pancreática , Microtomografia por Raio-X
16.
Biomarkers ; 24(3): 232-239, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30411980

RESUMO

Background: The aetiology and inflammatory profile of combined pulmonary fibrosis and emphysema (CPFE) remain uncertain currently. Objective: We aimed to examine the levels of inflammatory proteins in lung tissue in a cohort of patients with emphysema, interstitial pulmonary fibrosis (IPF), and CPFE. Materials and methods: Explanted lungs were obtained from subjects with emphysema, IPF, CPFE, (or normal subjects), and tissue extracts were prepared. Thirty-four inflammatory proteins were measured in each tissue section. Results: The levels of all 34 proteins were virtually indistinguishable in IPF compared with CPFE tissues, and collectively, the inflammatory profile in the emphysematous tissues were distinct from IPF and CPFE. Moreover, inflammatory protein levels were independent of the severity of the level of diseased tissue. Conclusions: We find that emphysematous lung tissues have a distinct inflammatory profile compared with either IPF or CPFE. However, the inflammatory profile in CPFE lungs is essentially identical to lungs from patients with IPF. These data suggest that distinct inflammatory processes collectively contribute to the disease processes in patients with emphysema, when compared to IPF and CPFE.


Assuntos
Inflamação/genética , Proteínas/genética , Enfisema Pulmonar/genética , Fibrose Pulmonar/genética , Idoso , Humanos , Inflamação/complicações , Inflamação/diagnóstico por imagem , Inflamação/patologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Mucina-5B/genética , Polimorfismo de Nucleotídeo Único , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/patologia , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/patologia , Tomografia Computadorizada por Raios X
17.
BMJ Case Rep ; 11(1)2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30567164

RESUMO

Superior vena cava syndrome (SVCS) is a group of symptoms caused by obstruction of superior vena cava. External compression caused by benign or malign processes is the most common physiopathology. We aim to present a 29-year-old man with non-productive cough, facial plethora and venous distention of the neck. Right apical tense bulla which was compress superior vena cava was detected and video-assisted thoracoscopic surgery applied. Our extensive search found out that only one report of SVCS secondary to bulla is available on Medline.


Assuntos
Enfisema Pulmonar/diagnóstico , Síndrome da Veia Cava Superior/diagnóstico , Adulto , Tosse/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Síndrome da Veia Cava Superior/etiologia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
19.
Int J Chron Obstruct Pulmon Dis ; 13: 3563-3570, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30464438

RESUMO

Introduction: There are no studies analyzing the relationship between emphysema and lung cancer (LC). With this aim and in order to make some comparisons between different clinical variables, we carried out the present study. Methods: This is a case-control study, patients with COPD and LC being the cases and subjects with stable COPD being the controls. Clinical and functional parameters, as well as the existence of radiological emphysema, were evaluated in a qualitative and quantitative way, using a radiological density of -950 Hounsfield units as a cutoff point in the images. The existence of several different types of emphysema (centrilobular, paraseptal, panacinar, or bullae) was analyzed, allowing patients to have more than one simultaneously. The extent to which lobes were involved was evaluated and the extension of emphysema was graduated for each type and location, following a quantitative scale. Differences between cases and controls were compared by using bivariate and multivariate analyzes with results expressed as OR and 95% CI. Results: We included 169 cases and 74 controls, 84% men with a FEV1 (%) of 61.7±18.5, with 90.1% non-exacerbators. Most of them (50%) were active smokers and 47.2% were ex-smokers. Emphysema was found in 80.2% of the subjects, the most frequent type being centrilobular (34.4%). The only significantly different factor was the presence of paraseptal emphysema (alone or combined; OR =2.2 [95% CI =1.1-4.3, P = 0.03]), with adenocarcinoma being significantly more frequent in paraseptal emphysema with respect to other types (67.2% vs 32.8%, P =0.03). Conclusion: Patients with COPD and paraseptal emphysema could be a risk group for the development of LC, especially adenocarcinoma subtype.


Assuntos
Adenocarcinoma de Pulmão/etiologia , Neoplasias Pulmonares/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/complicações , Adenocarcinoma de Pulmão/diagnóstico , Adenocarcinoma de Pulmão/fisiopatologia , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Fatores de Risco , Fumar/efeitos adversos
20.
Rev Esp Patol ; 51(4): 257-261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30269779

RESUMO

Smoking-related interstitial fibrosis is a distinct form of fibrosis, found in smokers, which has striking histopathological features. We present a case of pulmonary interstitial fibrosis with cysts in a 58-year-old woman who was a significant active smoker, presenting with a 7 month history of progressive dyspnea. TAC revealed thin-walled pulmonary cysts. An open lung biopsy was performed and the histopathological study showed hyaline fibrous thickening of the alveolar septa, respiratory bronchiolitis and cysts in the thickness of the interlobar septa. Immunohistochemically, the absence of an epithelial, vascular or lymphatic endothelial lining of the cysts would suggest that the cysts had been caused by pulmonary interstitial emphysema. Immunohistochemistry is essential in the differential diagnosis that includes, in this case, true cysts, pseudocysts and pulmonary lymphangiectasia.


Assuntos
Bronquiolite/patologia , Fumar Cigarros/efeitos adversos , Cistos/patologia , Imuno-Histoquímica , Doenças Pulmonares Intersticiais/patologia , Enfisema Pulmonar/complicações , Biomarcadores/análise , Biópsia , Cistos/diagnóstico por imagem , Cistos/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/metabolismo , Linfangiectasia/diagnóstico , Pessoa de Meia-Idade , Fumar , Tomografia Computadorizada por Raios X
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