Search

Longitudinal data on pulmonary function after pediatric allogeneic or autologous hematopoietic stem cell transplantation (HSCT) are rare. We examined pulmonary function and associated risk factors in 5-year childhood cancer survivors (CCSs) longitudinally. We included 74 CCSs diagnosed between 1976 and 2010, treated with HSCT, and with at least two pulmonary function tests performed during follow-up. Median follow-up was 9 years (range 6–13). We described pulmonary function as z-scores for lung volumes (forced vital capacity [FVC], residual volume [RV], total lung capacity [TLC]), flows (forced expiratory volume in 1 s [FEV1], maximal mid-expiratory flow [MMEF]), and diffusion capacity for carbon monoxide (DLCO) and assessed associations with potential risk factors using multivariable regression analysis. The median z-scores for FEV1, FVC, and TLC were below the expected throughout the follow-up period. This was not the case for RV, MMEF and DLCO. Female gender, radiotherapy to the chest, and relapse were associated with lower z-scores of FEV1, FVC, MMEF, RV or DLCO. Childhood cancer survivors after HSCT are at risk of pulmonary dysfunction. The complex and multifactorial etiology of pulmonary dysfunction emphasizes the need for longitudinal prospective studies to better characterize the course and causes of pulmonary function impairment in CCSs.

The long-term sequelae of COVID-19 on are not yet predictable. Radiological and histopathological data on COVID-19 and observational studies after the SARS-CoV-1 pandemic 2003/2004 suggest that in a proportion of COVID-19 patients, functional limitations due to pulmonary fibrosis and other patterns of lung damage may persist. Systematic follow-up, based on prudent pulmonary function testing, is warranted for the correct diagnosis, graduation and treatment of the underlying pathology at an early stage. This review summarizes the potential spectrum of Post-COVID-19 pulmonary disease patterns and provides recommendations for the follow-up care of COVID-19 patients in the field of respiratory medicine.

In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment. The upper-lobe predominant heterogeneous type of emphysema is the best indication, but there are other types of emphysema morphology that are also eligible for surgery, if ideally chosen. Nowadays there is also growing evidence for positive effects after different types of bronchoscopic lung volume reduction (BLVR) with increasing quality. These methods add to the range of multimodal emphysema treatment.

Microfibrillar-associated protein 4 (MFAP4) is localized to elastic fibers in blood vessels and the interalveolar septa of the lungs and is further present in bronchoalveolar lavage. Mfap4 has been previously suggested to be involved in elastogenesis in the lung. We tested this prediction and aimed to characterize the pulmonary function changes and emphysematous changes that occur in Mfap4-deficient ( Mfap4−/−) mice. Significant changes included increases in total lung capacity and compliance, which were evident in Mfap4−/−mice at 6 and 8 mo but not at 3 mo of age. Using in vivo breath-hold gated microcomputed tomography (micro-CT) in 8-mo-old Mfap4−/−mice, we found that the mean density of the lung parenchyma was decreased, and the low-attenuation area (LAA) was significantly increased by 14% compared with Mfap4+/+mice. Transmission electron microscopy (TEM) did not reveal differences in the organization of elastic fibers, and there was no difference in elastin content, but a borderline significant increase in elastin mRNA expression in 3-mo-old mice. Stereological analysis showed that alveolar surface density in relation to the lung parenchyma and total alveolar surface area inside of the lung were both significantly decreased in Mfap4−/−mice by 25 and 15%, respectively. The data did not support an essential role of MFAP4 in pulmonary elastic fiber organization or content but indicated increased turnover in young Mfap4−/−mice. However, Mfap4−/−mice developed a spontaneous loss of lung function, which was evident at 6 mo of age, and moderate air space enlargement, with emphysema-like changes.

Chirurgische Eingriffe über kleinste Zugänge, hauptsächlich unter dem Begriff der Schlüsselloch-Chirurgie bekannt, haben über die letzten Jahre zunehmend an Bedeutung gewonnen und sind in spezialisierten Händen mittlerweile für die Mehrzahl aller chirurgischen Eingriffe Standard. Nach anfänglichen Bedenken bezüglich der Radikalität ist das Verfahren heutzutage auch in der Tumorchirurgie etabliert. Die minimal-invasiven Interventionen haben allgemein zum Ziel, das Operationstrauma und die damit verbundenen körpereigenen Entzündungsreaktionen zu minimieren und dadurch eine raschere Genesung zu erreichen. Neben den augenscheinlichen kosmetischen Vorteilen kommt es erwiesenermaßen auch zu geringeren perioperativen Schmerzen und somit zu einer kürzeren und einfacheren Rehabilitationsphase sowie einer rascheren Wiedereingliederung in den Alltag beziehungsweise in den Arbeitsprozess. Die Behandlung der Bronchuskarzinome als häufigstes, zum Tod führendes Karzinom der Gesamtpopulation (15% aller Krebsdiagnosen und 29% aller krebsbedingten Todesfälle fallen auf Lungenkrebs), ist ein wichtiger Schwerpunkt der Thoraxchirurgie. Auch im Rahmen der neuesten multimodalen Therapiekonzepte, ist die radikale chirurgische Entfernung des Lungenkrebses ein unverzichtbarer Behandlungsschritt und Hauptpfeiler im kurativen Konzept. In den Frühstadien ist die thorakoskopische Lobektomie mit mediastinaler Lymphadenektomie der heutige Standard. Die in spezialisierten Zentren vorhandene Expertise, erlaubt es eine Vielzahl von Patienten, insbesondere auch in fortgeschrittenem Alter und mit deutlich eingeschränkter Lungenkapazität, einer minimal-invasiven kurativen Behandlung zuzuführen.

Purpose The predicted postoperative forced exspiratory volume in one second (FEV (1)) is an important functional factor for predicting the operability of patients with bronchial carcinoma. A software tool that uses a preoperative chest MSCT and pulmonary function test (PFT) for largely automated prediction of the FEV (1) was evaluated. Materials and methods Fifteen patients with surgically treated lung cancer were examined with a preoperative chest MSCT (1.25 mm slice thickness, 0.8 mm reconstruction increment) and PFT before and after surgery. CT scans were analyzed by the prototype software MeVisPulmo (MeVis gGmbH, Bremen) that predicted the postoperative FEV (1) as a percentage of the preoperative values measured by PFT. The automated segmentation and volumetry of lung lobes were performed either without or with minimal user interaction. Patients underwent lobectomy in twelve cases (6 upper lobes, 1 middle lobe, 5 lower lobes) and pneumectomy in three cases. The predicted FEV (1) values were compared to the observed postoperative values as a standard of reference. The additional functional parameters "total lung capacity" (TLC) and "forced vital capacity" (FVC) were compared to the FEV (1) results. Results Automated calculation of predicted postoperative lung function was successful in all cases. Due to an implausible PFT, two of the 15 patients were excluded from the collective. A mean postoperative FEV (1) value of 75 % (SD +/- 12 %) of the preoperative FEV (1) was calculated and 74 % (SD +/- 12 %) was actually measured. The deviations of the predicted value from the measured postoperative FEV (1) ranged between - 289 ml (-12 % of the measured postoperative FEV (1)) and + 294 ml (+ 15 % of the postoperative FEV (1)). The mean deviation (absolute value) was 137 +/- 77 ml/s. This corresponds to 7 +/- 3 % of the measured postoperative FEV (1). Bland-Altman-Statistics showed the 95 % "limits of agreement" for the predicted FEV (1) values to be between - 341 ml and + 301 ml, corresponding to - 17.5 % and + 15.8 of the measured postoperative FEV (1) value. Analysis of the TLC and FVC yielded similar results. Conclusion In the present pilot study the software-assisted prediction of the postoperative FEV (1) using a preoperative MSCT and pulmonary function test corresponded satisfactorily with the observed postoperative values. The introduced approach may make it possible to obtain additional information for the prediction of functional operability prior to performing lung cancer surgery.