Pulmonary Functional Reserve Research Articles

Clinical application of the COVID-19 Reporting and Data System (CO-RADS) in patients with suspected SARS-CoV-2 infection: observational study in an emergency department

• CO-RADS improves the risk classification by 65.8% in patients affected by COVID-19. • CO-RADS combined with RT-PCR presents an AUC of 0.98 for patients with COVID-19. • CO-RADS improves the risk classification by 82.1% in patients not affected by COVID-19.

Predictores de mortalidad en pacientes con hemoptisis en un servicio de emergencia

Introducción. La hemoptisis es una de las manifestaciones más alarmantes de las enfermedades broncopulmonares y representa el 7% de los ingresos hospitalarios a los servicios de medicina Interna. La hemoptisis severa está relacionada a cifras altas de mortalidad alrededor del 40%. Existen múltiples factores que cuando coexisten con hemoptisis alteran su evolución y pronóstico. No solo la severidad de la hemoptisis determina el riesgo de muerte, sino la presencia de comorbilidades, especialmente pulmonares que afectan la reserva funcional del paciente. Objetivos. Determinar la mortalidad y los factores que incrementan la mortalidad en pacientes con hemoptisis que son admitidos por un servicio de emergencia. Diseño. Estudio analítico. Institución. Servicio de emergencia, Hospital Nacional Dos de Mayo, Lima, Perú. Participantes. Pacientes con diagnóstico de hemoptisis. Métodos. Se revisaron 108 historias clínicas de pacientes que fueron hospitalizados por emergencia con diagnóstico de hemoptisis en un lapso de 2 años. Se recolectaron las variables edad, sexo, procedencia, presencia de comorbilidades, reserva funcional respiratoria cualitativa, entre otros. Los resultados se expresaron en distribución de frecuencias absolutas y relativas, medias (+1DE); los factores relacionados a incremento de mortalidad se les determinó mediante el estimado del riesgo relativo (RR). Para la comparación de proporciones se utilizó la prueba chi2. Para determinar las variables asociadas a mortalidad se usó el modelo de regresión logística múltiple. Principales medidas de resultados. Factores asociados a incremento de mortalidad. Resultados. Los factores asociados a incremento de mortalidad fueron la presencia de caverna mayor de 1 cm de diámetro, de localización hiliar, y el antecedente de readmisiones por hemoptisis. Así mismo, la presencia de fibrosis pulmonar que comprometía más de 50% del parénquima pulmonar bilateral fue importante predictor de mortalidad. Conclusiones. La reserva funcional pulmonar fue el determinante principal relacionado a mortalidad en pacientes con hemoptisis que fueron hospitalizados por emergencia.

Cryoablation of a Small Pulmonary Nodule with Pure Ground-Glass Opacity: A Case Report

Treatments for pure ground-glass nodules (GGNs) include limited resection; however, surgery is not always possible in patients with limited pulmonary functional reserve. In such patients, cryoablation may be a suitable alternative to treat a pure GGN. Here, we report our initial experience with cryoablation of a pure GGN that remained after repeated surgical resection in a patient with multiple GGNs. A 5-mm-sized pure GGN in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow-up.

Myocardial Protection Era: From Valve Surgery to Heart Transplantation

Myocardial Protection Era: From Valve Surgery to Heart Transplantation

Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software☆

The prediction of pulmonary functional reserve is mandatory in therapeutic decision-making for patients with resectable lung cancer, especially those with underlying lung disease. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative computed tomography (CT) helps to identify residual pulmonary function, although the utility of this modality needs investigation. The subjects of this prospective study were 30 patients with resectable lung cancer. A three-dimensional CT lung model was created with voxels representing normal lung attenuation (-600 to -910 Hounsfield units). Residual pulmonary function was predicted by drawing a boundary line between the lung to be preserved and that to be resected, directly on the lung model. The predicted values were correlated with the postoperative measured values. The predicted and measured values corresponded well (r=0.89, p<0.001). Although the predicted values corresponded with values predicted by simple calculation using a segment-counting method (r=0.98), there were two outliers whose pulmonary functional reserves were predicted more accurately by CT than by segment counting. The measured pulmonary functional reserves were significantly higher than the predicted values in patients with extensive emphysematous areas (<-910 Hounsfield units), but not in patients with chronic obstructive pulmonary disease. Quantitative CT yielded accurate prediction of functional reserve after lung cancer surgery and helped to identify patients whose functional reserves are likely to be underestimated. Hence, this modality should be utilized for patients with marginal pulmonary function.

Breath-hold single-photon emission tomography and computed tomography for predicting residual pulmonary function in patients with lung cancer

We sought to evaluate the utility of integrated breath-hold single-photon emission tomography and computed tomography imaging compared with that of simple calculation with the lung segment-counting technique for predicting residual pulmonary function in patients undergoing surgical intervention for lung cancer. A prospective series of 22 patients undergoing anatomic lung resection for cancer were enrolled in this study. Postoperative residual forced expiratory volume in 1 second was predicted by measuring the radioactivity counts of the affected lobes or segments to be resected within the entire lungs by placement of regions of interest on single-photon emission tomography and computed tomography images. Residual forced expiratory volume in 1 second was also estimated by using the segment-counting technique. Both predicted values agreed well with postoperative forced expiratory volume in 1 second. Although the residual forced expiratory volume in 1 second predicted by means of single-photon emission tomography and computed tomography correlated well with that predicted by using segment counting, the values were significantly underestimated by the segment-counting technique in 4 outliers with severe emphysema. There were 2 patients with borderline pulmonary functional reserve whose residual forced expiratory volume in 1 second values were predicted more accurately by means of single-photon emission tomography and computed tomography than by using segment counting. Integrated breath-hold single-photon emission tomography and computed tomography images allow the accurate prediction of postoperative pulmonary function but without statistical superiority over the simple segment-counting technique. Further study of the usefulness of single-photon emission tomography and computed tomography in patients with severe emphysema and borderline lung function should prove valuable because the segment-counting technique underestimates pulmonary functional reserve in these patients.

Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up.

Although outcome of resection for colorectal carcinoma has improved, about 30 percent of patients develop metastatic lesions. Small pulmonary metastases 1 cm or less in diameter now can be detected by diagnostic tests including chest radiography and computed tomography. We evaluated results of our strategy for intensive follow-up after resection of colorectal cancer and aggressive resection of lung metastases disclosed by these periodic examinations. Our follow-up program for lung metastasis includes a serum carcinoembryonic antigen assay every two months and chest radiography every six months. Surgical resection of lung metastases was performed if the primary and any nonpulmonary metastases had been controlled, lung metastases numbered four or fewer, and pulmonary functional reserve was adequate. Standard operation for lung metastasis was lobectomy, and lymph node dissection was added in cases of tumor size over 3 cm. Forty-two patients underwent 50 lung resections for metastatic colorectal cancer between 1992 and 1999. Long-term survival was assessed in terms of clinical variables. Overall five-year survival rate after resection of lung metastases from colorectal cancer was 63.7 percent. Variables significantly affecting postthoracotomy survival were primary tumor histology, number of nodules, and disease-free interval up to appearance of the lung metastases, and primary tumor histology was an independent prognostic factor. Intensive follow-up for lung metastases after resection of colorectal cancer and aggressive resection improved postoperative survival rate. Patients with well-differentiated adenocarcinoma of primary tumor, a solitary metastatic nodule, and disease-free interval of at least two years after initial surgery are likely to be long-term survivors.

The Influence of Aging on Pulmonary Function Tests in Elderly Korean Population

Background Many studies have shown that pulmonary function differs widely among race, age and geographical residency. By virtue of the improvement of nutrition and environment, the elderly population in Korea is markedly increasing and so are the ages of patients complaining respiratory symptoms. However, we do not have our own data on the pulmonary functional reserve of elderly persons in Korea. We evaluate the deterioration of pulmonary functional reserve and standardize the predictive values of pulmonary function in the elderly population. Method Pulmonary function tests were conducted in 100 men and 100 women over the age of 65. We analyzed changes of FVC and FEV1 according to age and height by linear regression. We compared our new multiple linear regression equation with other equations currently used in Korea. Results In men, the mean age was 71.5±5.2(mean±SD) years and the mean height was 163.6±6.2cm. The mean FVC was 3.42±0.49ℓ and the mean FEV1, 2.72±0.40ℓ. In women, the mean age was 72.0±5.1 years and the mean height was 149.1±5.9cm. The mean FVC was 2.22±0.42ℓ and the mean FEV1, 1.83±0.34ℓ. Multiple linear regression equation using age and height as an independent factors was as follows : FVC(ℓ)=1.857-0.0356×age(year)+0.02157×height(cm) (p<0.01, R2=0.279), FEV1(ℓ)=1.340-0.02698×age(year)+0.02021×height(cm) (p<0.01, R20.255) in men, FVC(ℓ)=-0.09765-0.03332×age(year)+0.03164×height(cm) (p<0.01, R2=0.435), FEV1(ℓ)=-0.169-0.02469×age(year)+0.02539×height(cm) (p<0.01, R2=0.41) in women. Conclusion We established prediction regressions for pulmonary functional tests in the elderly Korean population. We also confirmed that currently adopted equations do not exactly anticipate the expected pulmonary functional reserve in the aged person over 65 years old. We suggest that our new equations from this study should be applied to interpret the pulmonary function tests in the elderly population in Korea.

Current Concepts in the Perinatal Diagnosis and Management of Hydronephrosis

Perinatal urology has become a significant facet of pediatric urologic practice. This article reviews the approaches to the diagnosis of prenatal hydronephrosis and its typical sonographic appearances in relation to the underlying pathology. A review of the outcomes of prenatal uropathology serves as a basis on which to interpret reports of prenatal intervention for hydronephrosis. A critical review of the experience of prenatal intervention is conditionally supportive of its benefits, but this view must be tempered by a recognition of the inherent risk to the mother and fetus. Included within this view is a recognition that not all hydronephrosis is caused by obstruction. More specific prognostic indicators of renal and pulmonary functional reserve are critically needed to permit appropriate patient selection. This must be coupled with more rigorous assessment of outcomes and complete reporting of the results. Continued basic and clinical research is important in developing these data. A management strategy for hydronephrosis in the prenatal and postnatal periods is presented, based on the goal of permitting maximal renal as well as pulmonary development in utero and in the newborn period.

Studies on the Effects of Various Types of Collapse Therapy and Pulmonary Resection upon Cardiopulmonary Function in Patients with Pulmonary Tuberculosis (4) Extrapleural Synthetic Resion Plombage

Since the extrapleural synthetic resin plombage (hereafter abbreviated as plombage) was proposed by Nagaishi, it has sprad rapidly owing to its merit that it could dispense with the resection of ribs and could evoke the collapse of lesions selectively, thus making its disturbance upon pulmonary function rather slight. But in a little while it became to be scarcely practiced, chiefly according to the untoward postoperative complications. When plombage was adopted, studies on cardiopulmonary function were scarcely performed, and therefore there have been only a few reports on its effects upon cardiopulmonary function. This paper reports the present author's results of venous catheterization etc. on patients operated under plombage.Methods : The methods used for the venous catheterization etc. were similar to those in the first report of the present studies. The subjects were 5 patients under plombage, and one of them was similarly examined before operation.Results : The decrease in VC was pretty remarkable, while the decrease in MBC remained relatively slight. Minute ventilation was increased, but alveolar ventilation was normal, so alveolar ventilation ratio was found to be low. Arterial O2 saturation was normal, but in one of these patients, on whom muscular exercise was imposed, arterial O2 saturation dropped remarkably after exercise.Cardiac index tended to decrease in general, and it was decreased more remarkably in the group with high collapse than with moderate, and there was found statistically a significant difference between the two groups.Concerning pulmonary circulation, right auricular pressure was normal, but in the group with high collapse right ventricular pressure and pulmonary arterial pressure were both remarkably elevated, and the latter showed a significant difference between the two groups. Pulmonary arterial pressure showed a negative and a positive correlation with cardiac index and vascular resistance respectively.Vascular resistance was increased both in pulmonary arteriolar and in pulmonary vascular, and it was more remarkably in the group with high collapse than in the other. There was found a significant difference between the two groups. Work of right ventricle against pressure was normal.Comparing the results of one patient before and after operation, the decrease in VC remained very slight in spite of his high collapse, and arterial O2 saturation was elevated slightly, while both right ventricular pressure and pulmonary arterial pressure were clearly elevated after operation. Cardiac index decreased slightly and pulmonary vascular resistance increased remarkably after operation.Discussion and Conclusion : The decrease of VC in patients under plombage was greater than its decrease in tuberculous patients whose lesions were nearly the same. This may be due to the inevitable collapse of some amount of healthy lung parenchyma and to the pleural thickening complicated by operation. On the other hand the decrease of MBC after this operation was lighter than that of the tuberculous patients with lesions of similar degree. This is considered to be due to the needlessness of the resection of ribs and to the selective collapse of the lesions.Arterial O2 saturation was normal in general, and it was even elevated after operation in one of these patients. This is to be explained by the following facts. First, some amount of venous admixture coming from lesions decreased by the collapse of tuberculous part of the lung. Second, this operation does not injure the ventilation-perfusion relationships in other parts of the lung because the ribs are not resected. Thus any clear pulmonary insufficiency was not found at rest, while in one patient with high collapse arterial O2 saturation dropped remarkably after muscular exercise. This shows the decrease of pulmonary functional reserve, so clinicians must always be careful for it. [the rest omitted]