The Surgical Treatment of Emphysematous Blebs and Localized Vesicular and Bullous Emphysema

Head, James M.; Head, Louis R.; Hudson, Theodore R.; Head, Jerome R.

doi:10.1016/s0022-5223(19)32596-6

Cited by 22 publications

(2 citation statements)

References 14 publications

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“…Similar mechanisms were postulated in the early 19505 and led to unsuccessful surgical removal oflung tissue segments as potential treatment for emphysema. 13,20,21 In those instances, deterioration in overall lung function was frequently seen. Improved localization of dysfunctional lung areas with CT scanning and more directed intervention with laser approaches could explain improved short-term outcomes seen in patients who undergo laser treatment.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic laser ablation of pulmonary bullae: Radiographic selection and treatment response

Brenner¹,

Kayaleh²,

Milne³

et al. 1994

The Journal of Thoracic and Cardiovascular Surgery

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Radiographic selection and treatment responseThe purpose of this study was to develop objective preoperative selection methods for predicting outcome in patients undergoing thoracoscopic laser ablation of emphysematous pulmonary bullae. Initial radiographic presentation was correlated with physiologic function both before and after the operation in 24 patients entered into a prospective clinical protocol for evaluation of carbon dioxide laser treatment of emphysematous pulmonary bullae. Nineteen surviving patients underwent foDow-up evaluation 1 to 3 months after the operation. Pulmonary function test results showed improvements in spirometry (forced vital capacity increased 0.82 ± 0.125 L, forced expiratory volume in 1 second increased 0.36 ± 0.07 L, and maximum voluntary ventilation increased 11.69 ± 2.6 L/m; p < 0.002); airway resistance decreased by 0.9 ± 0.35 cm of water/L per second, and specific conductance increased 0.019 ± 0.006 L/cm H20 per second (p < 0.02). Lung volumes improved (residual volume decreased 1.25 ± 0.23 L, p < 0.001) without significant change in resting gas exchange. Quantitative radiographic grading of extent of preoperative pulmonary bullae correlated weD with response to laser treatment in patients with preoperative and postoperative studies. Patients with large bullae accompanied by crowding of adjacent lung structures, upper lobe predominance, and minimal underlying emphysema had greatest improvement in pulmonary function results with laser bullae ablation (p < 0.05). However, some patients with multiple smaDer bullae and diffuse emphysema also demonstrated objective improvement after operation. Quantitative radiographic analysis of the extent of bullous disease and the degree of associated emphysema can be used to determine short-term postoperative pulmonary response and may be useful in selecting future thoracoscopic laser bullae ablation candidates. Additional foDow-up will be necessary to further improve selection criteria and help define the long-term role of thoracoscopic laser treatment of bullous emphysema.

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Section: Discussionmentioning

confidence: 99%

Thoracoscopic laser ablation of pulmonary bullae: Radiographic selection and treatment response

Brenner¹,

Kayaleh²,

Milne³

et al. 1994

The Journal of Thoracic and Cardiovascular Surgery

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“…From then on, a variety of surgical options for obliteration of bullae were described; some, based on physiological misconceptions, were bizarre. Segmental resection, 29 lobectomy, 87 plication 3 and local excision 85 were suggested as suitable techniques for selected cases with well localized lesions of various sizes. Tracheostomy,…”

Section: Surgery Of Bullae and Diffuse Emphysemamentioning

confidence: 99%

Anaesthesia for the surgery of emphysema

Conacher¹

1997

British Journal of Anaesthesia

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Thoracic anaesthesia is now established in a third age. The first age related to surgery for infective conditions, predominantly tuberculosis, the second was defined by surgery for bronchogenic cancer and the third is surgery for respiratory failure. The anaesthetic imperatives of this latest age are epitomized by emphysema, with some variants treated with lung transplantation and, recently, surgery for the oxymoron, lung volume reduction. Small areas of emphysematous changes are common in the general population, occasionally resulting in pneumothoraces; a significant number of these patients require surgical intervention. The presence of large cystic areas or bullae, and bilateral, widespread diffuse areas of enlarged air spaces distal to terminal bronchioles 32 are much rarer and their management fraught with risk. Until the advent of lung volume reduction surgery, the anaesthetic literature was sparse, with mostly case reports and series involving small numbers. Personal experience of managing cases with moderate to severe respiratory failure, as a result of end-stage emphysematous disease, serves as an illustrative framework (table 1) and has much to teach about the dangers, how anaesthesia may contribute to morbidity and mortality, and where risks can be reduced. An early specimen of emphysema, purportedly the lung of Dr Samuel Johnson, is illustrated in Mathew Baillie's The Morbid Anatomy of Some of the Most Important Parts of the Human Body (London, Bulmer, 1812). 47 Laennec 42 described the clinical condition of dyspnoea, cyanosis, dry cough, over-inflated chest, cardiac hypertrophy and quiet respiratory sounds on auscultation. He recognized the continuum from the small areas of enlarged air cells, illustrated in his book, to the giant cyst or bulla. He foresaw pathognomonic features now so often seen on chest x-rays and CT scans, 74 noting that: "When this disease occupies only one side, or exists much more in one lung than the other, this side is evidently enlarged, and the intercostal spaces wider...........and instead of its natural compressed shape it (the chest)

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