Chest
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Hyperinflation in patients with severe COPD is associated with an increased anteroposterior (AP) rib cage diameter. We sought to determine whether bilateral lung volume reduction surgery (LVRS) affects bony thorax configuration. ⋯ We conclude that LVRS decreases mid-to-lower AP rib cage diameter as assessed by CXR and thoracic CT. Although transverse diameters were reduced on CXR, the magnitude was small and was not confirmed with CT. After LVRS, AP diameter reductions are most likely the result of reduction in lung volume, and they are associated with improvements in diaphragm strength and exercise endurance.
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Case Reports
Wegener's granulomatosis and alpha1-antitrypsin-deficiency emphysema: proteinase-related diseases.
Wegener's granulomatosis (WG) and alpha1-antitrypsin (alpha1-AT)-deficiency emphysema are both uncommon disorders. A relationship may exist between these diseases involving the proteinase and antiproteinase balance in the lung. ⋯ Previous studies concerning the correlation between abnormal alpha1-AT alleles and WG are discussed. Potential mechanisms for the relationship and recommendations for screening are given.
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Cigarette smoking is the prime cause of COPD; however, only a few smokers develop the disease. In a previous study, we demonstrated that microsatellite DNA instability (MSI) is a detectable phenomenon in sputum cells of COPD patients. Therefore, we hypothesize that this genetic alteration may indicate susceptibility to COPD. ⋯ This study demonstrated that MSI was found exclusively in the sputum cells of smokers with COPD. The results support the hypothesis that MSI could be part of the complex genetic basis of COPD, and it could be a marker of the genetic alteration caused by smoking that allows COPD to develop.
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Nasal continuous positive airway pressure (nCPAP) is the most common treatment for obstructive sleep apnea (OSA) in adults, and it has been effective in the treatment of OSA in children. We wanted to determine the effectiveness of long-term nCPAP therapy for OSA in infants. ⋯ nCPAP is an effective therapy for the management of OSA in infants, and it can be used effectively in the home environment. Regular follow-up is necessary, because the requirements for CPAP and pressure levels change with the infant's growth and development.
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To clarify the significance of a functional lung pattern characterized by a decreased vital capacity (VC) and an increased residual volume (RV), but with a normal FEV1/VC ratio. ⋯ A functional pattern characterized by a decreased VC and FEV1 and increased RV, but with a normal FEV1/VC ratio and total lung capacity, reflects an obstructive impairment of small airways.