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Yihenew Negatu, Philip T Diaz
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Frequent pneumonias and exacerbations are known to accelerate its progression. We present a case of severe emphysema whose lung function paradoxically improved following recurrent pneumonia, without lung volume reduction surgery (LVRS). A 54-year-old female with severe COPD presented for LVRS evaluation. She was not a candidate for the surgery because of the unsuitable anatomic distribution of her emphysema. The patient experienced recurrent pneumonia over the years but her lung function and oxygen requirement showed marked improvement...
2017: Case Reports in Medicine
Jarred R Mondoñedo, Béla Suki
Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (bLVR) are palliative treatments aimed at reducing hyperinflation in advanced emphysema. Previous work has evaluated functional improvements and survival advantage for these techniques, although their effects on the micromechanical environment in the lung have yet to be determined. Here, we introduce a computational model to simulate a force-based destruction of elastic networks representing emphysema progression, which we use to track the response to lung volume reduction via LVRS and bLVR...
February 2017: PLoS Computational Biology
Jkw Yap, D O'Neill, S Nagenthiran, C W Dawson, D M Luesley
Squamous cell carcinoma of the vulva is predominantly a disease of the elderly, where the mainstay of treatment is radical surgery. Local vulval recurrence (LVR) is a significant problem for these patients, and the rates of recurrence have not improved over the last three decades. Disappointingly, we still lack an understanding of how LVRs develop, and the best approach to prevent and manage the condition. This review discusses recent insights into the key prognostic factors that influence the risk of recurrence, focusing on the role of tumour-adjacent non-neoplastic epithelial disorders, which are thought to play a causative role...
January 12, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Miao Zhang, Heng Wang, Xue-Feng Pan, Wen-Bin Wu, Hui Zhang
The aim of the present study was to investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary emphysema (COPE). Eleven male patients with a mean age of 60.27±12.11 years with bilateral COPE and bullae were admitted to the Department of Thoracic Surgery, Xuzhou Central Hospital from January 2013 to June 2014. The patients underwent staged bilateral single-port thoracoscopic LVRS. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin...
November 2016: Experimental and Therapeutic Medicine
Priyadharshanan Ariyaratnam, Peter Tcherveniakov, Richard Milton, Nilanjan Chaudhuri
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether potential surgical candidates for lung volume reduction surgery (LVRS), who have preoperative hypercapnia, should be excluded on this basis. Using the reported search, 45 papers were found, of which 14 represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated...
October 26, 2016: Interactive Cardiovascular and Thoracic Surgery
Naveen Surendran, Ted Nicolosi, Michael Pichichero
We recently identified a population of 10% of infants who respond with sub-protective antibody levels to most routine primary pediatric vaccinations due to altered innate and adaptive immune responses. We term these infants as low vaccine responders (LVRs). Here we report new data showing that TLR7/8 agonist - R848 stimulation of PBMCs of LVR infants elicit significantly lower IFN-α, IL-12p70 and IL-1β, while inducing higher levels of CCL5 (RANTES) compared to normal vaccine responder (NVR) infants.
November 11, 2016: Vaccine
Joseph Em van Agteren, Kristin V Carson, Leong Ung Tiong, Brian J Smith
BACKGROUND: 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...
October 14, 2016: Cochrane Database of Systematic Reviews
C Caviezel, D Franzen, I Inci, W Weder
In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment...
September 2016: Zentralblatt Für Chirurgie
Hang Yu, Lijie Wang, Zhen Wu, Zhen Yang
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for severe emphysema, providing treatment options for patients who are unable to undergo lung volume reduction surgery (LVRS) or lung transplantation. Current BLVR techniques include bronchoscopic volume reduction with valve implants, use of a lung volume reduction coil (LVRC), bronchoscopic thermal vapor ablation (BTVA), biological lung volume reduction (BioLVR), and use of airway bypass stents (ABS). To date, several randomized controlled trials of these bronchoscopic therapies have been conducted in patients with emphysema, and bronchoscopic volume reduction with valve implants remains the best approach thus far...
November 15, 2016: Bioscience Trends
Bassam Redwan, Stephan Ziegeler, Michael Semik, Joachim Fichter, Nicolas Dickgreber, Volker Vieth, Erik Christian Ernst, Stefan Fischer
Lung volume reduction surgery (LVRS) is an important treatment option for end-stage lung emphysema in carefully selected patients. Here, we first describe the application of low-flow v-v extracorporeal CO2 removal (LFVV-ECCO2R) as bridge to LVRS in patients with end-stage lung emphysema experiencing severe hypercapnia due to acute failure of the breathing pump.Between March and October 2015, n = 4 patients received single-site LFVV-ECCO2R as bridge to LVRS.Indication for ECLS was severe hypercapnia with respiratory acidosis and acute breathing pump failure...
July 26, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
J Alberto Neder, Denis E O'Donnell
There has been a surge of interest in endoscopic lung volume reduction (ELVR) strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to derive benefit from ELVR procedures...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
J De Wolf, P Bonnette, É Sage, A Hamid
Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1≤45 %, TLC≥100 %, RV≥150 %, room air resting PaCO2≤60mmHg and PaO2≥45mmHg...
July 18, 2016: Revue des Maladies Respiratoires
M Bezzi, M Mondoni, C Sorino, P Solidoro
Lung volume reduction coil (LVRC) treatment is a minimally-invasive technique planned to achieve an improvement of exercise capacity and pulmonary function in subjects with advanced emphysema and hyperinflation. It has been proposed together with other bronchoscopic lung volume reduction approaches to reduce lung hyperinflation in emphysema as less invasive alternatives to LVRS and are currently under clinical investigation. Following the successful early experiences in previous pilot trials, recent studies allow further investigation into the feasibility, safety and efficacy of LVR coil treatment in a multi-center setting in a larger group of patients...
August 2015: Minerva Medica
Bartolome Celli, Kay Tetzlaff, Gerard Criner, Michael I Polkey, Frank Sciurba, Richard Casaburi, Ruth Tal-Singer, Ariane Kawata, Debora Merrill, Stephen Rennard
RATIONALE: The 6-minute-walk distance (6MWD) test predicts mortality in chronic obstructive pulmonary disease (COPD). Whether variability in study type (observational vs. interventional) or region performed limits use of the test as a stratification tool or outcome measure for therapeutic trials is unclear. OBJECTIVES: To analyze the original data from several large observational studies and from randomized clinical trials with bronchodilators to support the qualification of the 6MWD test as a drug development tool in COPD...
December 15, 2016: American Journal of Respiratory and Critical Care Medicine
Zhonghao Liu, Chengyu Jin, Raphael Lui, Rui Guo, Yongwei Yang, Xiaokaiti Maimaitiyiming, Chuanliang Peng
The aim of this study is to evaluate the safety and efficacy of lung volume reduction surgery (LVRS) by video-assisted thoracoscopic surgery (VATS) in the treatment of chronic obstructive pulmonary disease (COPD). A total of 90 patients with COPD from 2002 to 2012 were enrolled into our study, comprising 22 who underwent conventional thoracotomies and 68 VATS. Pulmonary function testings, arterial blood gases analysis, and quality of life between these two groups were compared. VATS was found to be superior to the conventional thoracotomy in terms of length of hospital stay, intraoperative blood loss, intubation time, volume of chest tube drainage, and postoperative pain assessment (P < 0...
April 2016: Indian Journal of Surgery
Noriane A Sievi, Christian F Clarenbach, Malcolm Kohler
BACKGROUND: Altered cardiac repolarization is a risk factor for sudden cardiac death and seems to be increased in chronic obstructive pulmonary disease (COPD) patients. OBJECTIVE: Lung volume reduction surgery (LVRS) has been shown to improve breathing mechanics and lung function in patients with severe COPD and emphysema and possibly also improve altered cardiac repolarization. METHODS: Thirty patients scheduled for LVRS were randomized to LVRS or to the control group...
2016: Respiration; International Review of Thoracic Diseases
J Stolk, W Broekman, T Mauad, J J Zwaginga, H Roelofs, W E Fibbe, J Oostendorp, I Bajema, M I M Versteegh, C Taube, P S Hiemstra
BACKGROUND: Mesenchymal stromal cells (MSCs) may reduce inflammation and promote tissue repair in pulmonary emphysema. AIM: To study the safety and feasibility of bone marrow-derived autologous (BM-) MSC intravenous administration to patients with severe emphysema. DESIGN: A phase I, prospective open-label study registered at as NCT01306513 Eligible patients had lung volume reduction surgery (LVRS) on two separate occasions...
May 2016: QJM: Monthly Journal of the Association of Physicians
Mark E Ginsburg, Byron M Thomashow, William A Bulman, Patricia A Jellen, Beth A Whippo, Cody Chiuzan, Shing Lee, Dan Bai, Joshua Sonett
OBJECTIVES: The National Emphysema Treatment Trial (NETT) validated the efficacy of lung-volume reduction surgery (LVRS) in selected patients with emphysema; however, concerns about the safety and durability of the operation have limited its clinical application. We evaluated our experience with LVRS, for the time period since approval was given by the Centers for Medicare and Medicaid Services, with respect to surgical morbidity and mortality, early and late functional outcomes, and long-term survival...
March 2016: Journal of Thoracic and Cardiovascular Surgery
M J Vorster, C F N Koegelenberg
Pathognomonic features of advanced emphysema include a markedly reduced alveolar surface area due to the formation of blebs and bullae and significantly reduced elastic recoil. The aim of lung volume reduction, which can be achieved by either surgery or endoscopic techniques, is volume loss of the targeted, diseased region(s) and redirecting airflow to less affected regions.Lung volume reduction surgery (LVRS) entails reducing the lung volume by wedge excision of emphysematous tissue. LVRS carries significant morbidity and mortality, but can offer survival benefit and increased exercise capacity in selected patients with predominantly upper-lobe emphysema and low exercise capacity...
September 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Liangchao Wang, Yi Hu, Xinrong Wang, Su Zhao
PURPOSE: To retrospectively analyze the efficacy and complications of lung volume reduction surgery (LVRS) using one-way valve stent implantation in three heterogeneous emphysema cases. METHODS: We performed bronchoscopic, lung CT, pulmonary function (PF) and 6-minute walk distance (6MWD) tests respectively before operation and 1 month, and 3 and 6 months after operation to estimate the surgical effects in the 3 cases by comparing the test results. RESULTS: After operation, all the three cases had worsened symptoms of cough and expectoration; two of them had hemoptysis, EVB-related infections and acute exacerbation of chronic obstructive pulmonary disease (AECOPD), one of them had airway distortion and respiratory failure and still one of them had granulation hyperplasia...
2015: International Journal of Clinical and Experimental Medicine
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