Extensive Emphysema Research Articles

Pathophysiology of hereditary emphysema.

Patients with decreased serum alpha1-antitrypsin were designated as severely deficient (7% to 15% of normal) or intermediately deficient (30% to 65% of normal) by quantitative radial immunodiffusion. All severely deficient patients were symptomatic and had severe emphysema. Among intermediately deficient patients emphysema was clinically evident only after age 50. Younger subjects had significant loss of lung elastic recoil and hyperinflation without expiratory flow obstruction. Older patients with an intermediate deficiency had abnormalities that were radiographically and physiologically identical to those of younger severely deficient patients. Postmortem examination of the lung of two patients with severe deficiency and one patient with intermediate deficiency showed extensive panlobular emphysema of the lower two thirds of the lungs, with relative sparing of the upper third. It is concluded that patients with intermediate alpha1-antitrypsin deficiency may develop emphysema identical to that found in severely deficient patients but at an older age.

Chronic obstructive disease of small airways.

The clinical, radiological, pathophysiological, and morphological features of seven patients with chronic airways obstruction characterized by chronic cough and expectoration are described. All had a reticular pattern on their chest roentgenogram. None had severe or extensive emphysema. Hypercapnia was chronic in four and transient in two. The lungs were not hyperinflated, but residual volume was increased. Pulmonary function tests showed airways obstruction. Mucous plugging, narrowing, and peribronchial fibrosis were variably present. The only morphological abnormality common to all was inflammation of small bronchi and bronchioles. These morphologic lesions may be principally responsible for the functional and possibly the roentgenographic abnormalities in these patients. Similar abnormalities are seen in small airways of patients dying from chronic bronchitis and emphysema and may be responsible for many of the functional derangements in these disorders.

Emphysema with hereditary alpha-1 antitrypsin deficiency masquerading as asthma

Ten patients among 11 persons homozygous for hereditary alpha-1 antitrypsin deficiency had chronic obstructive lung disease with exertional dyspnea as the prime symptom. Some also had wheezing and sputum production. Early in the course of the illness 5 of the patients were erroneously considered to have asthma. One patient was unique, lacking detectable levels at all. Assay of serum of family members was consistent with an autosomal codominant mode of inheritance in all families. Autopsy of the 2 patients who died showed extensive panacinar emphysema. One had in addition peribronchial inflammation, extensive squamous metaplasia of the tracheal and bronchial epithelium, and distinct degenerative changes of the tracheobronchial cartilage plaques.

Association between radiological findings and total and regional function in emphysema.

Tests of overall and regional lung function using xenon-133 with fixed counters were carried out on 49 patients who were judged on specified radiological grounds to have emphysema: 31 of them also had clinical evidence of chronic bronchitis. The radiological extent of the disease was classified as generalized, extensive localized or localized. The results of the tests were compared with the radiographic extent of the disease and with the local radiographic appearances. Derangements of total lung function agreed well with the radiological extent of the disease; in particular, the average level of Paco2 was lower than that predicted from the F.E.V.1 when generalized and extensive localized emphysema were present. Co-existing chronic bronchitis was associated with higher levels of Paco2. The resting Pao2 was higher if one or both lower regions were normally ventilated despite unevenness of ventilation elsewhere, emphasizing the importance of the lower lung regions in determining the overall V/Q of the lungs. Regional derangements of ventilation coincided fairly well with the radiographic distribution of vascular narrowing or loss but the blood flow was found to be diminished in less than 5% of upper and middle regions with radiological changes. Ventilation was impaired in parts of the lungs where the vascular shadows were apparently normal. This finding was attributed to the effects of chronic bronchitis, because it was also found in seven patients with this disease who did not have radiographic evidence of emphysema; in these, impairment of ventilation in the middle and lower regions was a salient feature.

Plasma cell tumour of trachea

A case of primary plasma cell tumour of the trachea is reported in a man with extensive bilateral bronchiectasis, chronic bronchitis and emphysema. The tracheal lesion was multiple, but there was no evidence either of metastatic spread to the regional lymphatic glands or of diffuse myeloma. The literature on extra-medullary plasma cell tumours is briefly reviewed with special reference to tracheal involvement.

Extensive mediastinal emphysema in a fatal case of laryngeal diphtheria; with remarks on the early and late variety of emphysema observed in the case after tracheotomy

The LaryngoscopeVolume 8, Issue 4 p. 262-263 Abstracts And BibliographyFree Access Extensive mediastinal emphysema in a fatal case of laryngeal diphtheria; with remarks on the early and late variety of emphysema observed in the case after tracheotomy First published: April 1900 https://doi.org/10.1288/00005537-190004000-00028AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume8, Issue4April 1900Pages 262-263 RelatedInformation

Case of Severe Fracture of the Ribs, with Extensive Emphysema

Case of Severe Fracture of the Ribs, with Extensive Emphysema