Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
Bronchoscopy ; Emphysema ; Endoscopy ; Humans ; Pneumothorax ; Pulmonary Emphysema

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
Bronchoscopy ; Emphysema ; Endoscopy ; Humans ; Pneumothorax ; Pulmonary Emphysema

Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.
Bronchoscopy ; Emphysema ; Pulmonary Medicine ; Pulmonary Surgical Procedures

PURPOSE: To evaluate the lung changes in healthy smokers, as seen on inspiratory and expiratoryhigh-resolution computed tomography (HRCT). MATERIAL AND METHODS: Twenty-seven healthy smokers (light smokers,below 20 pack-years, n=16; heavy smokers, above 20 pack-years, n=11) and 25 nonsmokers underwent inspiratory andexpiratory HRCT. All healthy smokers had normal pulmonary function and chest radiography. Parenchymal andsubpleural micronodules, ground-glass attenuation, centrilobular and paraseptal emphysema, bronchial wallthickening, bronchiectasis and septal line were evalvated on inspiratory scan and by air-trapping on expiratoryscan. RESULTS: On inspiratory scan, parenchymal micronodules were observed in one of 25 nonsmokers(4%), two of 16light smokers(13%) and five of 11 heavy smokers(45%); subpleural micronodules in two(8%), four(25%), two(18%);ground-glass attenuation in 0(0%), one(6%), three(27%); centrilobular emphysema in 0(0%), one(6%), three(27%);paraseptal emphysema in three(12%), 0(0%), five(45%); bronchial wall thickening in 0(0%), two(13%), one(9%),bronchiectasis in 0(0%), one(6%) two(18%) and septal line in one(4%), four(25%), two(18%). On expiratory scan,air-trapping was detected in 0 of 15 nonsmokers(0%), two of 17 light smokers(12%), and five of 11 heavysmokers(45%). Statistically significant differences between these three groups were found in parenchymalmicronodules(P=0.006), ground-glass attenuation(P=0.008), centrilobular emphysema(P=0.018), paraseptal emphysema(P=0.005) and air-trapping(P=0.013) between these three groups. CONCLUSION: According to the findings of HRCT,heavy smokers had higher frequency of parenchymal micronodules, ground-glass attenuation, centrilobular andparaseptal emphysema, and air-trapping than nonsmokers and light smokers.
Bronchiectasis ; Bronchiolitis ; Emphysema ; Lung* ; Pulmonary Emphysema ; Radiography ; Thorax

PURPOSE: The purpose of this study was to compare high-resolution CT(HRCT) findings of asthmatic and control subjects, and to evaluate the relationship between HRCT findings and clinical features in asthmatic subjects. MATERIALS AND METHODS: Using HRCT, we studied 16 asthmatic and 16 control subjects. We analyzed the ratio of bronchial wall thickeness, the frequency of bronchial dilatation, the presence of emphysema, centrilobular nodule, and pulmonary infiltration in two groups. In addition, we assessed HRCT findings of asthmatic patients for correlation with clinical findings and the pulmonary function test. RESULTS: The ratio of bronchial wall thickness of 16 asthmatic subjects (0.48 +/-0.08) and 16 control subjects(0.40 +/-0.08) was significantly different in statistical analysis (P<0.001). Bronchial dilatation was seen in 53(32%) of 165 bronchi in the asthmatic group and in 16(13%) of 119 bronchi in the control group, which was statistically significant (p<0.01). Among 16 asthmatic patients, there were eight cases of emphysema, two of centrilobular nodule, and four of pulmonary infiltration. The ratio of bronchial wall thickeness of eight asthmatic subjects with emphysema(0.47 +/-.08) and eight such subjects without emphysema(0.49 +/-0.09) was not significantly different when statistically analysed. In asthmatic patients, HRCT findings did not correlate with clinical findings and the pulmonary function test. CONCLUSION: On high-resolution CT, the ratio of bronchial wall thickness and the frequency of bronchial dilatation between asthmatic and control subjects are significantly different.
Bronchi ; Dilatation ; Emphysema ; Humans ; Pulmonary Emphysema ; Respiratory Function Tests

Adenocarcinoma presenting as a solitary mass with a cavity in chest computed tomogram is rare. A few reports have suggested an association between lung cancer and emphysema. We report a case of adenocarcinoma surrounding pulmonary emphysema that mimicked fungal pneumonia. This case highlights the need for cliniclians to be aware of the potential development of lung cancer in patients with emphysema.
Adenocarcinoma* ; Emphysema* ; Humans ; Lung ; Lung Neoplasms ; Pneumonia* ; Pulmonary Emphysema ; Thorax

Adenocarcinoma presenting as a solitary mass with a cavity in chest computed tomogram is rare. A few reports have suggested an association between lung cancer and emphysema. We report a case of adenocarcinoma surrounding pulmonary emphysema that mimicked fungal pneumonia. This case highlights the need for cliniclians to be aware of the potential development of lung cancer in patients with emphysema.
Adenocarcinoma* ; Emphysema* ; Humans ; Lung ; Lung Neoplasms ; Pneumonia* ; Pulmonary Emphysema ; Thorax

Spirometry provides objective information about pulmonary function and assesses the results of therapy. Pulmonary function testes early in the course of COPD reveal only evidence of dysfunction in small airways. Reduction in forced expiratory volume in 1 second (FEV1) and in the ratio of forced expiratory volume to forced vital capacity (FEV1, FVC) occurs later. In severe disease, the forced vital capacity is markedly reduced. Lung volume measurements revealed increase in the total lung capacity (TLC), marked increase in the residual volume (VR), and elevation of the VR/TLC ratio, indicative of air trapping, particularly in emphysema
Emphysema ; diagnosis ; physiology ; Pulmonary Ventilation ; asthma

In this study, the effect of prophylactic anti-inflammation on the development of smoke-induced emphysema was investigated. Young male guinea-pigs aged 1.5-2 months (weighing 198.3+/-26.9 g) were randomly divided into 4 groups: group A (cigarette smoke exposure only), group B (cigarette smoke exposure plus pentoxifylline-rich (PTX, 10 mg/d) forage feeding), group C (cigarette smoke exposure plus intermittent cortical steroid injection (Triamcinolone acetonide, 3 mg, i.m., every three weeks) and control group (group D: animals with sham smoke exposure, raised under the same conditions). Animals in group A, B and C were exposed to smoke of cigarettes for 1 to 1.5 h twice a day, 5 days a week. All animals were killed at the 16th week and followed by morphometrical analysis of the midsagittal sectioned lung slices. Smoke exposure of 16 weeks resulted in visible emphysematous development in Group A but not in Group B and C. It was evidenced by the indicator of air-space size, mean linear intercept (Lm): 120.6+/-16.0 microm in Group A; 89.8+/-9.2 microm in Group B and 102.4+/-17.7 microm in Group C. The average Lm in either group B or group C was shorter than that in Group A (ANOVA and Newman-Keuls test, F=8.80, P=0.0002) but comparable to that (94.8+/-13.2 microm) in group D (P>0.05). It is concluded that long-term prophylactic anti-inflammation inhibits pulmonary emphysema induced by cigarette smoking in the guinea pigs.
Anti-Inflammatory Agents/*pharmacology ; Pentoxifylline/pharmacology ; Pulmonary Emphysema/etiology ; Pulmonary Emphysema/pathology ; Pulmonary Emphysema/*prevention & control ; Random Allocation ; Smoking/*adverse effects ; Triamcinolone Acetonide/*pharmacology

BACKGROUND: The correlation between the high resolution computed tomography(HRCT) emphysema score and the physiologic parameters including resting and exercise pulmonary function test was investingated in 14 patients(60.6±10.3 years) with pulmonary emphysema. METHODS: The patients underwent a HRCT, a resting pulmonary function test, and incremental exercise testing(cycle ergometer, 10 W/min). Computed tomography scans were obtained on a GE highlight at 10 mm intervals using 10 mm collimation, from the apex to the base after a full inspiration. The emphysema scores wer determined by a CT program 'Density mask' outlining the areas with attenuation values less than -900 HU, indicating the emphysema areas, and providing an overall percentage of lung involvement by emphysema. RESULTS: Among the resing PFT parameters, only the diffusing capacity(r=-0.75) and PaO2 (r=-0.66) correlated with the emphysema score(p<0.05). Among the exercise test parameers, the emphysema score correlated significantly with the maximum power(r=-0.74), maximum oxygen consumption(r=-0.68), anaerobic threshold(V-slope method : r=-0.69), maximal O2-pulse(r=-0.73), and the physiologic dead space ratio at the maximum workload(r=-0.80)(p<0.01). CONCLUSION: We could find that exercise testing parameters showed a much better correlation with the HRCT emphysema score, which is known to have a good correlation with the pathologic severity than the resting PFT parameters. Therefore it is suggested that exercise testing is superior to resting PFT for estimating in the estimation of the physiologic disturbance in emphysema patients.
Emphysema* ; Exercise Test ; Humans ; Lung ; Oxygen ; Pulmonary Emphysema ; Respiratory Function Tests