Archive for the ‘Lung’ Category - Part 2

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Thoracoscopic Techniques

Lausberg et al recently reported a method of radiofrequency-induced fenestrations in segmental bronchi to enhance expiratory airflow in emphysematous lungs. Twelve explanted emphysematous lungs removed during lung transplantation were studied in a ventilation chamber ex vivo. Three to five fenestrations were made in segmental or subsegmental bronchi adjacent to lung parenchyma with a radiofrequency catheter […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Total lung capacity

The nebulized papain produced histologically confirmed emphysema. Total lung capacity (TLC), RV, and RV/TLC increased in all animals. Lung compliance increased as well. After intubation and ventilation with 100% oxygen, selected lung subsegments were lavaged with “antisurfactant” solution via a multichannel, balloon-tipped catheter inserted through a fiberoptic bronchoscope. Following suction, a fibrin-based sealant was injected […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Bronchopleural fistula

In an animal study, 21 valves were inserted into the upper lobes of five healthy swine. After 4 to 6 days, bronchoscopy and fluoroscopy confirmed proper positioning of the valves. One valve in each of the four swine was easily removed and replaced bronchoscopically. No complications were observed. At thoracotomy 4 to 6 days after […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Procedure

Twenty-five endobronchial valves were inserted over a guide-wire placed bronchoscopically under general IV anesthesia with pressure-limited ventilation. Valves were inserted unilaterally in all segmental bronchi leading to the upper lobe most affected by emphysema in each patient. Median procedure time was 1 h (range 0.5 to 2.5 h). All patients were extubated immediately following the […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Bronchus

The Emphasys Endobronchial Valve consists of a silicone duckbill, one-way valve attached to a nitinol self-expanding stent retainer with silicone seals to occlude the bronchus around the valve (Fig 1). The valve is inserted into the intended segmental or subsegmental bronchus via a delivery housing device over a guidewire placed via a fiberoptic bronchoscope in […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Bronchoscopic Methods

The demonstrated benefits of LVRS and the rigors of surgical lung volume reduction have led investigators and medical equipment manufacturers to develop minimally invasive techniques to achieve lung volume reduction without open thoracotomy. Devices and techniques under study include bronchial occlusion devices inserted via fiberoptic bronchoscopy, promotion of focal atelectasis and fibrosis by bronchoscopic injection […]

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction

Emphysema is characterized by destruction of alveolar walls distal to the terminal bronchioles. This process leads to enlargement of distal air spaces with development of emphysematous blebs, cysts, and bullae. Because capillary-rich alveolar walls are also destroyed in areas of emphysema, these enlarged air spaces have very high ventilation/perfusion (V/Q) ratios creating physiologic dead space. […]

Methacholine-Induced Temporal Changes in Airway Geometry and Lung Density by CT: Discussion methacholine-induced bronchoconstriction

An increase in regional lung air content in the lung during methacholine-induced bronchoconstriction would suggest air trapping. Air trapping as measured by nonimaging methods has been shown to occur in response to methacholine, presumably due to closure of peripheral airways. However, it is also possible that constriction of peripheral airways may serve to expand alveoli […]

Methacholine-Induced Temporal Changes in Airway Geometry and Lung Density by CT: Discussion

Several investigators- have shown HRCT to be a useful tool in assessing airway reactivity. Those studies, along with other imaging methods,” have utilized single time points to assess airway response, and no previous study has directly assessed density changes associated with induced bronchoconstricmaximal response to a bolus of methacholine to pigs as detected by CT […]

Methacholine-Induced Temporal Changes in Airway Geometry and Lung Density by CT: Results

As shown in Figure 3, both normal (standard) and sharp reconstruction algorithms yielded nearly identical measurements of lung density for the same image (slope = 1.006, r = 0.99). Thus we used the sharp (high resolution) reconstruction algorithm for both airway CSA and lung density measurements. An example of the CT images obtained from the […]

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