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• W2113247958 abstract "We read with great interest the recent paper by J. C. Chen and associates1Chen JC Serna DL Powell LL Huh J McKenna Jr, R Fischel RJ et al.Diffusing capacity limitations of the extent of lung volume reduction surgery in an animal model of emphysema.J Thorac Cardiovasc Surg. 1999; 117: 728-735Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar about the diffusing capacity limitations of the extent of lung volume reduction surgery (LVRS) in animal models of emphysema. The authors induced diffuse emphysema by aerosol elastase, a model similar to the homogenous type of human emphysema. However, patients with emphysema who are good candidates for LVRS tend to have heterogeneous targeted areas for resection,2Weder W Thurnheer R Stammberger U Burge M Russi EW Bloch KE Radiologic emphysema morphology is associated with outcome after lung volume reduction.Ann Thorac Surg. 1997; 64: 313-320Abstract Full Text PDF PubMed Scopus (125) Google Scholar as Cooper has mentioned.1Chen JC Serna DL Powell LL Huh J McKenna Jr, R Fischel RJ et al.Diffusing capacity limitations of the extent of lung volume reduction surgery in an animal model of emphysema.J Thorac Cardiovasc Surg. 1999; 117: 728-735Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In these patients, improvement in respiratory system compliance is prominent even after resection of a large volume of the lung. In contrast, diffusing capacity deteriorated when the resected volume exceeded a threshold. In the setting of major lung resection, diffusing capacity may predict the postoperative morbidity and mortality.3Ferguson MK Reeder LB Mick R Optimizing selection of patients for major lung resection.J Thorac Cardiovasc Surg. 1995; 109: 275-283Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar We believe that the importance of diffusing capacity in LVRS needs to be emphasized. The goal of LVRS should be a balance between improving mechanical function of the lung and diaphragm without excessive loss of diffusing capacity or of the pulmonary vascular bed. We congratulate Chen and associates for raising this important issue. In Dallas, we4Carlin JI Hsia CCW Cassidy SS Ramanathan M Crifford PS Johnson RL Recruitment of lung diffusing capacity with exercise before and after pneumonectomy in dogs.J Appl Physiol. 1991; 70: 135-142Crossref PubMed Scopus (56) Google Scholar, 5Johnson RL Hsia CCW Functional recruitment of pulmonary capillary.J Appl Physiol. 1994; 76: 1405-1407Crossref PubMed Scopus (18) Google Scholar have performed extensive studies to determine the diffusion limitation after major lung resection at rest and during exercise. Here, we would like to introduce a method of assessing the diffusing capacity and septal lung tissue volume in vivo using combined radiologic and physiologic techniques. We believe this approach has potentially important applications in LVRS. With the use of an acetylene and a carbon monoxide rebreathing method, lung air volume, tissue volume, diffusing capacity, and cardiac output can be simultaneously and noninvasively measured.4Carlin JI Hsia CCW Cassidy SS Ramanathan M Crifford PS Johnson RL Recruitment of lung diffusing capacity with exercise before and after pneumonectomy in dogs.J Appl Physiol. 1991; 70: 135-142Crossref PubMed Scopus (56) Google Scholar In addition, tissue volume and air volume were also separately estimated by computed tomographic (CT) scan, from which topologic distribution of tissue and air volumes are obtained.6Takeda S Wu EY Epstein RH Estrera AS Hsia CCW In vivo assessment of changes in air and tissue volumes after pneumonectomy.J Appl Physiol. 1997; 82: 1340-1348PubMed Google Scholar We compared tissue volume measured by these 2 techniques in immature dogs at different ages. Half the dogs had undergone resection of the right lung; the other half had undergone thoracotomy without lung resection. We6Takeda S Wu EY Epstein RH Estrera AS Hsia CCW In vivo assessment of changes in air and tissue volumes after pneumonectomy.J Appl Physiol. 1997; 82: 1340-1348PubMed Google Scholar found significant correlations (P < .01) between tissue volume measured by CT and rebreathing and between tissue volume and diffusing capacity in both groups (Fig 1, A and B ).These data suggest that tissue volume is an anatomic correlate of gas exchange capacity. The article by Chen and associates reinforces the point that the key functional parameter of gas exchange is not total lung volume, but diffusing capacity and tissue volume. Measurement of diffusing capacity and tissue volume may aid the functional evaluation of patients with emphysema, although their predictive value in the setting of LVRS requires further investigation. For example, preoperative measurement of diffusing capacity and tissue volume by the rebreathing method could identify patients with insufficient gas exchange reserves who would not benefit from LVRS regardless of improvements in mechanical lung and respiratory muscle function. In addition, one could potentially use CT scan to map out the topologic distribution of tissue volume and to target regions with a low tissue volume (high air/tissue volume ratio) for resection." @default.
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• W2113247958 title "In vivo estimation of septal lung tissue volume and correlation with diffusing capacity in lung volume reduction surgery" @default.
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• W2113247958 doi "https://doi.org/10.1016/s0022-5223(00)70249-2" @default.
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