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John B. West - One of the best experts on this subject based on the ideXlab platform.
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understanding pulmonary gas exchange ventilation perfusion relationships
American Journal of Physiology-lung Cellular and Molecular Physiology, 2004Co-Authors: John B. WestAbstract:This essay looks at the historical significance of four APS classic papers that are freely available online: Fenn WO, Rahn H, and OTIS AB. A theoretical study of the composition of the Alveolar Air at altitude. Am J Physiol 146: 637-653. 1946 (http://ajplegacy.physiology.org/cgi/reprint/146/5/637). Rahn H. A concept of mean Alveolar Air and the ventilation-bloodflow relationships during pulmonary gas exchange. Am J Physiol 158: 21-30, 1949 (http://ajplegacy.physiology.org/cgi/reprint/158/1/21)). Riley RL. And Cournand A. "Ideal" Alveolar Air and the analysis of ventilation-perfusion relationships in the lungs. J Appl Physiol 1: 825-847. 1949 (http://jap.physiology.org/cgi/reprint/1/12/825). Riley RL. And Cournand A. Analysis of factors affecting partial pressures of oxygen and carbon dioxide in gas and blood of lungs: theory. J Appl Physiol 4: 77-101. 1951 (http://jap.physiology.org/cgi/reprint/4/2/77).
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understanding pulmonary gas exchange ventilation perfusion relationships
Journal of Applied Physiology, 2004Co-Authors: John B. WestAbstract:This essay looks at the historical significance of four APS classic papers that are freely available online: Fenn WO, Rahn H, and Otis AB . A theoretical study of the composition of the Alveolar Air at altitude. Am J Physiol 146: 637—653, 1946 ( ). Rahn H . A concept of mean Alveolar Air and the ventilation-bloodflow relationships during pulmonary gas exchange. Am J Physiol 158: 21—30, 1949 ([http://ajplegacy.physiology.org/cgi/reprint/158/1/21][1]). Riley RL and Cournand A . “Ideal” Alveolar Air and the analysis of ventilation-perfusion relationships in the lungs. J Appl Physiol 1: 825—847, 1949 ( ). Riley RL and Cournand A . Analysis of factors affecting partial pressures of oxygen and carbon dioxide in gas and blood of lungs: theory. J Appl Physiol 4: 77—101, 1951 ( ). [1]: http://ajplegacy.physiology.org/cgi/reprint/158/iss/21
Meinoshin Okumura - One of the best experts on this subject based on the ideXlab platform.
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clinical usefulness of free subcutaneous fat pad for reduction of intraoperative Air leakage during thoracoscopic pulmonary resection in lung cancer cases
Surgical Endoscopy and Other Interventional Techniques, 2015Co-Authors: Yasushi Shintani, Masayoshi Inoue, Soichiro Funaki, Tomohiro Kawamura, Masato Minami, Meinoshin OkumuraAbstract:Introduction Intraoperative Alveolar Air leaks remain a significant problem in thoracoscopic surgery (TS) cases. We examined the usefulness of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative Air leakage in patients with non-small cell lung cancer (NSCLC).
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use of free subcutaneous fat pad for reduction of intraoperative Air leak in thoracoscopic pulmonary resection cases with lung cancer
European Journal of Cardio-Thoracic Surgery, 2014Co-Authors: Yasushi Shintani, Masayoshi Inoue, Tomoyuki Nakagiri, Meinoshin OkumuraAbstract:Intraoperative Alveolar Air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative Air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3–4 cm anterior utility incision. When an Air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad 2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2–3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged Air leak (>7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 ± 2.6 postoperative days and the chest tubes removed at 3.2 ± 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.
Yasushi Shintani - One of the best experts on this subject based on the ideXlab platform.
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clinical usefulness of free subcutaneous fat pad for reduction of intraoperative Air leakage during thoracoscopic pulmonary resection in lung cancer cases
Surgical Endoscopy and Other Interventional Techniques, 2015Co-Authors: Yasushi Shintani, Masayoshi Inoue, Soichiro Funaki, Tomohiro Kawamura, Masato Minami, Meinoshin OkumuraAbstract:Introduction Intraoperative Alveolar Air leaks remain a significant problem in thoracoscopic surgery (TS) cases. We examined the usefulness of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative Air leakage in patients with non-small cell lung cancer (NSCLC).
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use of free subcutaneous fat pad for reduction of intraoperative Air leak in thoracoscopic pulmonary resection cases with lung cancer
European Journal of Cardio-Thoracic Surgery, 2014Co-Authors: Yasushi Shintani, Masayoshi Inoue, Tomoyuki Nakagiri, Meinoshin OkumuraAbstract:Intraoperative Alveolar Air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative Air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3–4 cm anterior utility incision. When an Air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad 2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2–3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged Air leak (>7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 ± 2.6 postoperative days and the chest tubes removed at 3.2 ± 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.
Peter Goldstraw - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized trial comparing bioglue and vivostat for the control of Alveolar Air leak
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Elizabeth Belcher, Eric Lim, George Ladas, Michael Dusmet, Simon Jordan, Peter GoldstrawAbstract:Objective BioGlue (CryoLife, Europa Ltd, Surrey, UK) is effective in reducing Alveolar Air leak after pulmonary resection. However, concerns exist regarding the use of bovine-derived products. Vivostat (Vivostat A/S, Alleroed, Denmark) is an autologous fibrin sealant that confers certain advantages. It shows superior elastic properties, a faster absorption time, and the absence of risk of transmission of blood-borne diseases. Methods We conducted a randomized, single blind controlled study to compare BioGlue and Vivostat in the control of postoperative Air leak. Primary endpoints were duration of Air leak, time to intercostal drain removal, and length of hospital stay. Secondary endpoints related to postoperative complications. Results Between December 2005 and December 2007, 103 patients were randomized. The analysis included 102 patients; 67% were male. Median age was 56 ± 19 years. Indications for surgery were primary lung cancer in 41 patients (40%), secondary malignancy in 48 patients (47%), carcinoid in 6 patients (6%), and 7 patients underwent surgery for benign disease (7%). Bilobectomy was performed in 2 patients (2%), lobectomy in 41 patients (40%), lobectomy with lesser resection in 3 patients (3%), segmentectomy in 16 patients (16%), precision excision in 34 patients (33%), and 6 patients underwent other resections (6%). Median duration of Air leak was 3 (0–32) days versus 2 (0–33) days for patients who received BioGlue and Vivostat, respectively ( P = .677). Time to intercostal drain removal was 5 (1–32) days in the BioGlue group compared with 5 (1–34) days for the Vivostat group ( P = .473). Median hospital stay was 8 (3–22) days versus 7 (2–29) days for the BioGlue and Vivostat groups, respectively ( P = .382). There was no significant difference in the incidence of complications between the 2 groups (20 patients receiving BioGlue versus 19 patients receiving Vivostat, P = .839). Conclusions There were no significant differences in the 3 clinical outcome measures of duration of Air leak, time to intercostal drain removal, and length of hospital stay in those patients receiving BioGlue or Vivostat. Given the inherent advantages of our institutional preference is to use Vivostat in the control of postoperative Air leaks after pulmonary resection.
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a prospective randomized controlled trial of the effectiveness of bioglue in treating Alveolar Air leaks
The Journal of Thoracic and Cardiovascular Surgery, 2006Co-Authors: Patrick Tansley, Faisal Almulhim, Eric Lim, George Ladas, Peter GoldstrawAbstract:Objective The use of tissue glues has been advocated to reduce post-thoracotomy Alveolar Air leaks, but outcomes have been inconclusive. The aim of this study was to determine the effectiveness of BioGlue (CryoLife Europa Ltd, Hampshire, United Kingdom) in eliminating post-thoracotomy Alveolar Air leaks. Methods A prospective, randomized, single-blind, controlled trial was conducted in which patients were stratified according to the severity of post-thoracotomy Air leak that could not be controlled by conventional surgical techniques. They were allocated to a control arm (surgical treatment only) or an interventional arm (surgical treatment and BioGlue). Duration of Air leak, intercostal drainage, and hospital stay comprised primary study end points. Results From December 2002 to January 2005, 52 patients were randomized, 29 (56%) of whom were men. The mean age was 59 ± 15 years, and other characteristics were comparable in both groups. Indications for surgery were malignancy in 46 patients (88%), carcinoid tumor in 2 patients (4%), and infective disease in 4 patients (8%). Patients in the BioGlue arm had shorter median duration of Air leaks, 1 (0-2) versus 4 (2-6) days ( P P = .012); and hospital stay, 6 (5-7) versus 7 (7-10) days ( P = .004), compared with controls. No major complications were encountered using BioGlue. Conclusions This study demonstrates clear benefit from BioGlue in the treatment of Alveolar Air leaks through reduction of Air leak duration, chest drainage time, and hospital stay. Systematic use of BioGlue may be warranted in adult thoracic surgical procedures (except pneumonectomy and decortication) when an Air leak remains after all other steps to control it have failed.
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effect of fibrin glue in the reduction of postthoracotomy Alveolar Air leak
The Annals of Thoracic Surgery, 1997Co-Authors: Kit Wong, Peter GoldstrawAbstract:Abstract Background . Intraoperative use of fibrin glue has been advocated in reducing postthoracotomy Alveolar Air leak, although most studies have not been randomized and have focused on its routine use after lung resection. Method . This study specifically addresses the effectiveness of fibrin glue in reducing Alveolar Air leak only in patients considered intraoperatively to have continued moderate to severe Alveolar Air leak after all conventional measures to reduce it have been used. Results . During a 24-month period, 66 patients undergoing lobectomies, segmentectomies, or decortication were randomized either to serve as controls (n = 33) or to have fibrin glue sprayed on the “raw” lung surface (n = 33). The median duration of intercostal drainage and in-hospital stay was 6 and 9 days, respectively, in the control group and 6 and 8 days, respectively, when fibrin glue was used. Statistical analysis revealed no differences between the groups. Conclusion . Fibrin glue does not add to conventional techniques in reducing moderate to severe Alveolar Air leak after thoracic operations.
C H Durney - One of the best experts on this subject based on the ideXlab platform.
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Alveolar Air tissue interface and nuclear magnetic resonance behavior of normal and edematous lungs
American Journal of Respiratory and Critical Care Medicine, 1995Co-Authors: A Cutillo, Krishnamurthy Ganesan, David C Ailion, Alan H Morris, Kenneth C Goodrich, Suetaro Watanabe, C H DurneyAbstract:The Alveolar Air/tissue interface markedly affects the NMR properties of lungs by causing an NMR signal loss as a result of internal (tissue-induced) magnetic field inhomogeneity. The signal loss can be measured as the difference in NMR signal intensity (difference signal delta) between a pAir of images obtained using temporally symmetric and asymmetric spin-echo sequences. Previous data indicate that the difference signal measured at an asymmetry time of 6 ms (delta 6ms) is very low in degassed lungs and increases markedly with Alveolar opening. Theoretically, the NMR behavior of edematous lungs is expected to differ from that of normal nondegassed lungs because Alveolar flooding and collapse are equivalent to partial (regional) degassing. To test this prediction, we measured delta 6ms in normal and edematous (oleic acid-injured) excised unperfused rat lungs at 5, 10, 20, 30, and 0 (full passive deflation) cm H2O inflation pressure (PL). Lung volume changes were estimated from NMR lung water density (pH2...
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Alveolar Air tissue interface and nuclear magnetic resonance behavior of lung
Journal of Applied Physiology, 1991Co-Authors: A Cutillo, Krishnamurthy Ganesan, David C Ailion, Alan H Morris, C H Durney, S C Symko, Rebecca ChristmanAbstract:Inflated lungs are characterized by a short nuclear magnetic resonance (NMR) free induction decay (rapid disappearance of NMR signal), likely due to internal (tissue-induced) magnetic field inhomogeneity produced by the Alveolar Air-tissue interface. This phenomenon can also be detected using temporally symmetric and asymmetric NMR spin-echo sequences; these sequences generate a pAir of NMR images from which a difference signal (delta) is obtained (reflecting the signal from lung water experiencing the Air-tissue interface effect). We measured delta in normal excised rat lungs at inflation pressures of 0-30 cmH2O for asymmetry times (a) of 1-6 ms. Delta was low in degassed lungs and increased markedly with Alveolar opening when measured at a = 6 ms (delta 6 ms); delta 6 ms varied little during the rest of the inflation-deflation cycle. Delta 1 ms (a = 1 ms) did not vary significantly on inflation and deflation. Measurements of delta at a = 3 and 5 ms generally lay between those of delta 1 ms and delta 6 ms. These findings, which are consistent with theoretical predictions, suggest that measurements of delta at appropriate asymmetry times are particularly sensitive to Alveolar opening and may provide a means of distinguishing Alveolar recruitment from Alveolar distension in the pressure-volume behavior of the lung.