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The aim of lung volume reduction surgery is to alleviate the symptoms of severe emphysema and to improve the life quality of the patient. The appropriate candidates (approximately 20% of all emphysematic patients examined in our clinic) had considerable dyspnea, an increased lung capacity, and a heterogenous dissemination of the emphysema with regional destruction of the parenchyma, hyperinflation and poor perfusion. After preoperative physiotherapie with a specified rehabilitation aim, a resection of 20 to 30% of the total lung volume was performed via sternotomy. From January 1993 to February 1996, 150 patients underwent bilateral lung volume reduction (age range = 36 to 77 years). The mean forced expiratory volume in 1 s (FEV1) was preoperatively 25% of the predicted value, the total lung capacity (TLC) 142% and the residual volume (RV) 283%, 94% of these patients necessitated oxygen supply at rest or during exercise. The 90-day mortality was 4%. All patients except 1 were extubated immediately after operation. The median hospital stay was 10 days in the first 100 patients and 7 days in the last 50. An increase of the FEV1 by 51% and a decrease of the RV by 28% was observed 6 months after operation. The mean PaO2 was improved by 8 mm Hg while the percentage of oxygen dependent patients went down from 50 to 16%. In addition a raise of the perseverance capacity, a clear decrease of dyspnea and an improvement of the life quality were achieved. These results persist after 1 (n = 56) and 2 (n = 20) years after operation. Lung volume reduction leads to an improvement of the lung function, symptoms and the quality of life, which is superior to that achieved by maximal clinical intervention.

Lung volume reduction (LVR) for advanced emphysema improves lung function and restores respiratory excursion of chest wall and diaphragm. Between January 1993 and February 1996, bilateral LVR via sternotomy was performed in 150 patients with an early mortality (60 days) of 2% (3/150). In 90 patients, FEV1 rose from 0.7 (24% pred.) preoperatively to 1.1 L (37% pred.) at 6 months (57% increase; p0.001). In the same interval, O2 requirements decreased during exercise from 95 to 46% of patients and from 50 to 16% of patients on continuous O2. After 1 (n = 54) and 2 (n = 15) years, the improvements in FEV1, pO2, 6-min walking distance, and dyspnea, and the reduction of TLC and RV remained stable. In selected patients, bilateral LVR results in marked improvement of emphysema-related disability and offers excellent palliation.

In a series of 6 dogs we performed an autotransplantation of a four-ring segment of the thoracic trachea. In 3 cases the omentum was brought into the chest and wrapped around the transplant (omentum group) and compared with the others (control group). After 20 days or at occurrence of severe tracheal stenosis the study was determined. In the omentum group all tracheal transplants healed with structural integrity. Microfil injection into the gastro-epiploic artery demonstrated revascularization through omental vessels. In the control group all transplants developed a severe stenosis due to chondromalacia within 2 weeks.The omentum can successfully revascularize a transplant of a four-ring segment of the thoracic trachea.

Ischemia of the airway is the main cause of severe complications in lung transplantation. Tissue-pH is used as an indicator of ischemia in the myocardium and various other tissues. We developed a pH needle probe which can be applied through a bronchoscope to enable repeated measurements of the pH in the bronchus mucosa. In 8 conditioned mongrel dogs (20-25 kg) an autotransplant of a 4-ring segment of the thoracic trachea was performed and wrapped with an omental pedicle flap in 4 of them (omentum group vs control group). PH-measurements of the mucosa were performed at 3 points of the circumference of the normal trachea as well as the transplant. The measurements were done immediately postoperative and at day 3, 8, 14 and 20 using a modified MI 506 pH-needle electrode with an Ag-AgCl skin reference electrode and a Fisher accumet pH-meter (model 910). After 3 weeks or at occurrence of a severe tracheal stenosis macroscopic and histologic examination of the trachea was done. All animals in the omentum group finished the study. One developed severe stenosis due to tracheal malacia. Three of the four control-dogs had a severe tracheal stenosis at day 12, 13 and 16 which necessitated termination of the experiment. The pH-difference between trachea and transplant immediately postoperative was 0.16 +/- 0.02 in the 4 dogs with healed transplants and 0.15 + 0.03 in the 4 dogs with stenosis due to chondromalacia. Follow-up measurements at day 3 and 8 showed a pH-difference of 0.2 for the group with chondromalacia vs. 0.1 for the healed tracheas (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)