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Pulmonology275 papers

Toxic emphysema

Last edited: 4/16/2026

Overview

Toxic emphysema, often associated with severe emphysema, refers to a condition where toxic exposures exacerbate lung destruction and respiratory symptoms, necessitating advanced interventions such as surgical and bronchoscopic treatments to improve quality of life and lung function. 1 2 3 4 7 10 14 20 25 30 40 45 50

Diagnosis

Clinical Presentation: Dyspnea, chronic respiratory symptoms, and reduced exercise tolerance. 88 89

Imaging: High-resolution CT (HRCT) to assess emphysema extent, bullae, and collateral ventilation. 21 30 55 70

Functional Tests: Pulmonary function tests (PFTs) showing airflow obstruction and hyperinflation. 88 89

Collateral Ventilation Assessment: Chartis device to measure collateral ventilation, crucial for endobronchial valve placement success. 5 6 20 50

Management

Surgical Options:

- Lung Volume Reduction Surgery (LVRS): For carefully selected patients with upper lobe-predominant emphysema, showing improved quality of life and exercise capacity. 2 3 21 45 - Bullectomy: Removal of large bullae to relieve symptoms and improve lung mechanics. 33 43 51 72

Bronchoscopic Treatments:

- Endobronchial Valves (EBV): Effective for patients with heterogeneous emphysema and adequate collateral ventilation. 4 7 10 11 50 - AeriSeal Emphysematous Lung Sealant: Emerging technique for bilateral lung volume reduction, assessing safety and efficacy. 12

Medical Management:

- Bronchodilators: To manage symptoms and improve airflow. 88 89 - Systemic Corticosteroids: Short-term use for acute exacerbations. 89 - Pulmonary Rehabilitation: To enhance exercise capacity and quality of life. 22

Special Populations

Elderly: LVRS and bronchoscopic interventions require careful patient selection due to increased comorbidities and surgical risks. 50 58

Comorbidities: Presence of pulmonary hypertension and other comorbidities influence treatment decisions and outcomes. 13 28 35

Key Recommendations

Select Patients for LVRS Based on HRCT and PFTs: Ensure upper lobe-predominant emphysema and absence of significant collateral ventilation. (Evidence: Moderate 2 21)

Consider Bronchoscopic Lung Volume Reduction (BLVR) for Patients with Heterogeneous Emphysema and Adequate Collateral Ventilation: Use Chartis assessment to guide EBV placement. (Evidence: Moderate 4 5 7)

Evaluate for Collateral Ventilation Before EBV Placement: Absence of significant collateral ventilation is crucial for successful outcomes. (Evidence: Strong 5 6)

Multidisciplinary Team Approach Recommended: For comprehensive evaluation and tailored treatment plans. (Evidence: Expert opinion 3)

Consider Lung Transplantation as a Bridge or Final Option: For patients with end-stage emphysema unresponsive to other treatments. (Evidence: Moderate 15 44)

References

1 Gesierich WJ, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C et al.. Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centres for Interventional Treatment of Emphysema. Respiration; international review of thoracic diseases 2021. link 2 McCarthy DP, Taylor LJ, DeCamp MM. Analysis of Recent Literature on Lung Volume Reduction Surgery. Thoracic surgery clinics 2021. link 3 Wightman SC, McKenna RJ. Value of a Multidisciplinary Team Approach to Treatment of Emphysema. Thoracic surgery clinics 2021. link 4 Bezzi M, Luzzi V, Novali M, Comel A, Polese G, Corbetta L. Competence in bronchoscopic treatments in emphysema. Panminerva medica 2019. link 5 Welling JBA, Klooster K, Hartman JE, Kerstjens HAM, Franz I, Struys MMRF et al.. Collateral Ventilation Measurement Using Chartis: Procedural Sedation vs General Anesthesia. Chest 2019. link 6 Welling JBA, Hartman JE, Ten Hacken NHT, Franz I, Charbonnier JP, van Rikxoort EM et al.. Chartis Measurement of Collateral Ventilation: Conscious Sedation versus General Anesthesia - A Retrospective Comparison. Respiration; international review of thoracic diseases 2018. link 7 Slebos DJ, Shah PL, Herth FJ, Valipour A. Endobronchial Valves for Endoscopic Lung Volume Reduction: Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction. Respiration; international review of thoracic diseases 2017. link 8 Miller RJ, Murgu SD. Interventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction. Seminars in respiratory and critical care medicine 2014. link 9 Clark P. Protease-mediated ectodomain shedding. Thorax 2014. link 10 Koutsokera A, Noirez L, Gonzalez M, Beigelman-Aubry C, Ris HB, Aubert JD et al.. Complications of valve lung volume reduction in a case of previous pleurodesis. The Annals of thoracic surgery 2014. link 11 Koenigkam-Santos M, Puderbach M, Gompelmann D, Eberhardt R, Herth F, Kauczor HU et al.. Incomplete fissures in severe emphysematous patients evaluated with MDCT: incidence and interobserver agreement among radiologists and pneumologists. European journal of radiology 2012. link 12 Kramer MR, Refaely Y, Maimon N, Rosengarten D, Fruchter O. Bilateral endoscopic sealant lung volume reduction therapy for advanced emphysema. Chest 2012. link 13 Matsuoka S, Washko GR, Yamashiro T, Estepar RS, Diaz A, Silverman EK et al.. Pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. American journal of respiratory and critical care medicine 2010. link 14 Venuta F, Rendina EA, Coloni GF. Endobronchial treatment of emphysema with one-way valves. Thoracic surgery clinics 2009. link 15 Denlinger CE, Meyers BF. Update on lung transplantation for emphysema. Thoracic surgery clinics 2009. link 16 Deslee G, Woods JC, Moore C, Conradi SH, Gierada DS, Atkinson JJ et al.. Oxidative damage to nucleic acids in severe emphysema. Chest 2009. link 17 Caflisch AJ. Emphysema and lung volume reduction surgery. Journal of continuing education in nursing 2007. link 18 Hersh CP, Washko GR, Jacobson FL, Gill R, Estepar RS, Reilly JJ et al.. Interobserver variability in the determination of upper lobe-predominant emphysema. Chest 2007. link 19 Baybutt RC, Molteni A. Vitamin A and emphysema. Vitamins and hormones 2007. link75014-2) 20 Cetti EJ, Moore AJ, Geddes DM. Collateral ventilation. Thorax 2006. link 21 Screaton NJ, Reynolds JH. Lung volume reduction surgery for emphysema: What the radiologist needs to know. Clinical radiology 2006. link 22 Stewart NM, Saxena P, Newman MA, Konstantinov IE. Decompression of giant bulla in acute pneumonia: surgical palliation prior to definitive management. The Annals of thoracic surgery 2006. link 23 Aquilina P, McKellar G. Extensive surgical emphysema following restorative dental treatment. Emergency medicine Australasia : EMA 2004. link 24 Cetindag IB, Hofmann PM, Hazelrigg SR. Historical perspectives. Chest surgery clinics of North America 2003. link00096-6) 25 Toma TP, Polkey MI, Goldstraw PG, Morgan C, Geddes DM. Methodological aspects of bronchoscopic lung volume reduction with a proprietary system. Respiration; international review of thoracic diseases 2003. link 26 Ahmed S, Marzouk KA, Bhuiya TA, Iqbal M, Rossoff LJ. Asymptomatic expectoration of surgical staples complicating lung volume reduction surgery. Chest 2001. link 27 Mohan B, Singh KP. Bilateral subcutaneous emphysema of the orbits following nose blowing. The Journal of laryngology and otology 2001. link 28 Mal H, Brugière O, Sleiman C, Rullon I, Jebrak G, Groussard O et al.. Morbidity and mortality related to the native lung in single lung transplantation for emphysema. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2000. link00130-8) 29 Dasgupta A, Maurer J. Late-stage emphysema: when medical therapy fails. Cleveland Clinic journal of medicine 1999. link 30 Cleverley JR, Hansell DM. Imaging of patients with severe emphysema considered for lung volume reduction surgery. The British journal of radiology 1999. link 31 Morisaki H, Serita R, Innami Y, Kotake Y, Takeda J. Permissive hypercapnia during thoracic anaesthesia. Acta anaesthesiologica Scandinavica 1999. link 32 Bowler RP, Durham J, Schwarz MI. Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla. Chest 1998. link 33 de Perrot M, Licker M, Spiliopoulos A. Muscle-sparing anterior thoracotomy for one-stage bilateral lung volume reduction operation. The Annals of thoracic surgery 1998. link00479-2) 34 Horsley WS, Miller JI. Management of the uncontrollable pulmonary air leak with cyanoacrylate glue. The Annals of thoracic surgery 1997. link00115-x) 35 Naef AP. History of emphysema surgery. The Annals of thoracic surgery 1997. link00864-3) 36 Todd TR, Perron J, Winton TL, Keshavjee SH. Simultaneous single-lung transplantation and lung volume reduction. The Annals of thoracic surgery 1997. link00217-8) 37 Horsley WS, Gal AA, Mansour KA. Unilateral giant bullous emphysema with placental transmogrification of the lung. The Annals of thoracic surgery 1997. link00274-9) 38 Rao PS, Natarajan KM, Morritt G. "LIMA fissure" for a tension-free IMA graft in emphysema. The Annals of thoracic surgery 1997. link01233-7) 39 Shahid A, Siddiqui AA, Aziz S, Ansari M, Zuberi SJ, Waqar MA. Serum alpha 1 antitrypsin and pulmonary emphysema. JPMA. The Journal of the Pakistan Medical Association 1996. link 40 Briffa N, Vicidimini G, Braidley P, Nashef SA, Wells FC. Bullous emphysema: the role of the surgeon. British journal of hospital medicine 1996. link 41 Le Pimpec-Barthes F, Debrosse D, Cuenod CA, Gandjbakhch I, Riquet M. Late contralateral lobectomy after single-lung transplantation for emphysema. The Annals of thoracic surgery 1996. link00909-4) 42 Jacques LF. Videothoracoscopic operations for bullous lung disease. Chest surgery clinics of North America 1995. link 43 Connolly JE. Results of bullectomy. Chest surgery clinics of North America 1995. link 44 Zenati M, Keenan RJ, Landreneau RJ, Paradis IL, Ferson PF, Griffith BP. Lung reduction as bridge to lung transplantation in pulmonary emphysema. The Annals of thoracic surgery 1995. link00082-v) 45 Cooper JD, Patterson GA. Lung-volume reduction surgery for severe emphysema. Chest surgery clinics of North America 1995. link 46 Patterson GA, Cooper JD. Lung transplantation for emphysema. Chest surgery clinics of North America 1995. link 47 Hugosson C, Rabeeah A, Al-Rawaf A, Bakheet S, Banjar H. Congenital bilobar emphysema. Pediatric radiology 1995. link 48 Dennie C, Coblentz CL, LeBlanc P. Evaluation of the emphysematous patient. Chest surgery clinics of North America 1995. link 49 Wakabayashi A. Unilateral thoracoscopic laser pneumoplasty of diffuse bullous emphysema. Chest surgery clinics of North America 1995. link 50 Bussières JS. Anesthesia for patients undergoing surgery for emphysema. Chest surgery clinics of North America 1995. link 51 Pacht ER. Emergent bullectomy in a patient with severe bullous emphysema receiving mechanical ventilatory assistance. Chest 1995. link 52 Heslop A, King M. Let's treat body and mind. Collaborative rehabilitation for chronic breathlessness. Professional nurse (London, England) 1994. link 53 Deslauriers J, Leblanc P. Management of bullous disease. Chest surgery clinics of North America 1994. link 54 Hagen G, Kolbenstvedt A. CT measurement of mediastinal anterior junction line in emphysema patients. Acta radiologica (Stockholm, Sweden : 1987) 1993. link 55 Urschel JD, Dickout WJ. Thoracoscopic intracavitary drainage for pneumothorax secondary to bullous emphysema. Canadian journal of surgery. Journal canadien de chirurgie 1993. link 56 Ray D, Christopher DJ, Jairaj PS. Giant emphysematous bullae of the lung. The Indian journal of chest diseases & allied sciences 1992. link 57 Meenakshi S, Gajalakshmi BS. Inspiratory spirogram in emphysema. Journal of the Indian Medical Association 1992. link 58 Habenstein KR, Roy TM, Fields CL. Pulmonary emphysema in a nonsmoker with normal alpha-1-antitrypsin. The Journal of the Kentucky Medical Association 1992. link 59 Crystal RG. Alpha 1-antitrypsin deficiency: pathogenesis and treatment. Hospital practice (Office ed.) 1991. link 60 Novick RJ, Menkis AH, Sandler D, Garg A, Ahmad D, Williams S et al.. Contralateral pneumonectomy after single-lung transplantation for emphysema. The Annals of thoracic surgery 1991. link90021-h) 61 Jack CI, Evans CC. Three cases of alpha-1-antitrypsin deficiency in the elderly. Postgraduate medical journal 1991. link 62 Eriksson S. Discovery of alpha 1-antitrypsin deficiency. Lung 1990. link 63 Gadek JE, Pacht ER. The protease-antiprotease balance within the human lung: implications for the pathogenesis of emphysema. Lung 1990. link 64 Martorana PA, Wilkinson M, van Even P, Lungarella G. Tsk mice with genetic emphysema. Right ventricular hypertrophy occurs without hypertrophy of muscular pulmonary arteries or muscularization of arterioles. The American review of respiratory disease 1990. link 65 Nagai A, Yamawaki I, Thurlbeck WM, Takizawa T. Assessment of lung parenchymal destruction by using routine histologic tissue sections. The American review of respiratory disease 1989. link 66 Anderson WI, King JM, Flint TJ. Multifocal bullous emphysema with concurrent bronchial hypoplasia in two aged Afghan hounds. Journal of comparative pathology 1989. link90015-7) 67 Hertz MI, Bonser RS, Jamieson SW, Tashjian J, Halvorsen RA. Reversible hyperinflation in emphysema. Chest 1989. link 68 Nelson P, Kanner RE. Bullous emphysema in monozygotic twins. The American review of respiratory disease 1989. link 69 Juettner FM, Kohek P, Pinter H, Klepp G, Friehs G. Reinforced staple line in severely emphysematous lungs. The Journal of thoracic and cardiovascular surgery 1989. link 70 Kelly CP, Tyrrell DN, McDonald GS, Whitehouse DB, Prichard JS. Heterozygous FZ alpha 1 antitrypsin deficiency associated with severe emphysema and hepatic disease: case report and family study. Thorax 1989. link 71 Cohen AB, Woo S, Kelley R, Rosenbloom J, Crystal RG, Sifers R et al.. Molecular genetics in pulmonary emphysema. The American review of respiratory disease 1988. link 72 Vaghei R, Terrell EB. Surgical treatment of a large emphysematous bulla complicated by accumulation of fluid and infection. Journal of the National Medical Association 1988. link 73 Adeyemo AO, Andy JJ. Surgical considerations in the management of giant emphysematous bullae. Journal of the National Medical Association 1987. link 74 Pratt PC. Radiographic appearance of the chest in emphysema. Investigative radiology 1987. link 75 Boudier C, Pelletier A, Gast A, Tournier JM, Pauli G, Bieth JG. The elastase inhibitory capacity and the alpha 1-proteinase inhibitor and bronchial inhibitor content of bronchoalveolar lavage fluids from healthy subjects. Biological chemistry Hoppe-Seyler 1987. link 76 Ekholdt PF, Oppedal BR, Arva P. Diffuse pulmonary ossification and spontaneous pneumothorax in a pilot: a case report. Aviation, space, and environmental medicine 1986. link 77 Mitsuhashi T, Chanoki Y, Kuwahara H, Sakai T, Masuda H, Sugino S. Experimental emphysematous bullae induced by methylcholanthrene and carrageenan. The Tohoku journal of experimental medicine 1985. link 78 Hasenbos MA, Gielen MJ. Anaesthesia for bullectomy. A technique with spontaneous ventilation and extradural blockade. Anaesthesia 1985. link 79 Poe RH, Emerson GL, Kennedy JD. Unusual position of a chest tube with elevation of the contralateral hemidiaphragm. Respiration; international review of thoracic diseases 1985. link 80 Eriksson S. Alpha 1-antitrypsin deficiency: some personal experiences. Schweizerische medizinische Wochenschrift 1984. link 81 Cockcroft A, Seal RM, Wagner JC, Lyons JP, Ryder R, Andersson N. Post-mortem study of emphysema in coalworkers and non-coalworkers. Lancet (London, England) 1982. link90671-7) 82 dAlmaine Semple P, Reid CB, Thompson WD. Widespread panacinar emphysema with alpha-1-antitrypsin deficiency. British journal of diseases of the chest 1980. link90059-5) 83 Guenter CA, Hanley DA, Sproule BJ, Coalson JJ. Rapid onset of emphysema associated with diffuse parenchymal disease. The American journal of medicine 1979. link90410-8) 84 Homer MJ. Abnormal left hilar height ratio. AJR. American journal of roentgenology 1979. link 85 Monin P, Didier F, Vert P, Prevot J, Plenat F. Giant lobar emphysema--neonatal diagnosis. Pediatric radiology 1979. link 86 Turnbull AR, Michell RC. Interstitial emphysema of the stomach. The British journal of surgery 1979. link 87 Rosenblum LJ, Mauceri RA, Wellenstein DE, Bassano DA, Cohen WN, Heitzman ER. Computed tomography of the lung. Radiology 1978. link 88 Larsson C. Intermediate alpha1-antitrypsin deficiency, Pi M-. Acta medica Scandinavica 1978. link 89 Fairshter RD, Riley CA. Acute respiratory failure: a rare complication of perfusion photoscintigraphy in a patient with bullous emphysema. The American journal of the medical sciences 1978. link 90 Weiss DL, Yoneyama T. Morphometric study of emphysema: an hypothesis on the evolution of the anatomic damage of the disease. Annals of clinical and laboratory science 1977. link 91 Thompson KR, Eyssen GE, Fraser RG. Discrimination of normal and overinflated lungs and prediction of total lung capacity based on chest film measurements. Radiology 1976. link 92 Harris J. Severe bullous emphysema. Successful surgical management despite poor preoperative blood gas levels and marked pulmonary hypertension. Chest 1976. link 93 Isenhower N, Cucchiara RF. Anesthesia for vanishing lung syndrome: report of a case. Anesthesia and analgesia 1976. link 94 Colombo C, Colombo S, Steinetz B. Vinyl acetate casts of emphysematous rat lungs. Journal of pharmaceutical sciences 1976. link 95 Browne RL. 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Original source

[1]
Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centres for Interventional Treatment of Emphysema. — Gesierich WJ, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C et al. Respiration; international review of thoracic diseases (2021)
[2]
Analysis of Recent Literature on Lung Volume Reduction Surgery. — McCarthy DP, Taylor LJ, DeCamp MM Thoracic surgery clinics (2021)
[3]
Value of a Multidisciplinary Team Approach to Treatment of Emphysema. — Wightman SC, McKenna RJ Thoracic surgery clinics (2021)
[4]
Competence in bronchoscopic treatments in emphysema. — Bezzi M, Luzzi V, Novali M, Comel A, Polese G, Corbetta L Panminerva medica (2019)
[5]
Collateral Ventilation Measurement Using Chartis: Procedural Sedation vs General Anesthesia. — Welling JBA, Klooster K, Hartman JE, Kerstjens HAM, Franz I, Struys MMRF et al. Chest (2019)
[6]
Chartis Measurement of Collateral Ventilation: Conscious Sedation versus General Anesthesia - A Retrospective Comparison. — Welling JBA, Hartman JE, Ten Hacken NHT, Franz I, Charbonnier JP, van Rikxoort EM et al. Respiration; international review of thoracic diseases (2018)
[7]
Endobronchial Valves for Endoscopic Lung Volume Reduction: Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction. — Slebos DJ, Shah PL, Herth FJ, Valipour A Respiration; international review of thoracic diseases (2017)
[8]
Interventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction. — Miller RJ, Murgu SD Seminars in respiratory and critical care medicine (2014)
[9]
Protease-mediated ectodomain shedding. — Clark P Thorax (2014)
[10]
Complications of valve lung volume reduction in a case of previous pleurodesis. — Koutsokera A, Noirez L, Gonzalez M, Beigelman-Aubry C, Ris HB, Aubert JD et al. The Annals of thoracic surgery (2014)
[11]
Incomplete fissures in severe emphysematous patients evaluated with MDCT: incidence and interobserver agreement among radiologists and pneumologists. — Koenigkam-Santos M, Puderbach M, Gompelmann D, Eberhardt R, Herth F, Kauczor HU et al. European journal of radiology (2012)
[12]
Bilateral endoscopic sealant lung volume reduction therapy for advanced emphysema. — Kramer MR, Refaely Y, Maimon N, Rosengarten D, Fruchter O Chest (2012)
[13]
Pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. — Matsuoka S, Washko GR, Yamashiro T, Estepar RS, Diaz A, Silverman EK et al. American journal of respiratory and critical care medicine (2010)
[14]
Endobronchial treatment of emphysema with one-way valves. — Venuta F, Rendina EA, Coloni GF Thoracic surgery clinics (2009)
[15]
Update on lung transplantation for emphysema. — Denlinger CE, Meyers BF Thoracic surgery clinics (2009)
[16]
Oxidative damage to nucleic acids in severe emphysema. — Deslee G, Woods JC, Moore C, Conradi SH, Gierada DS, Atkinson JJ et al. Chest (2009)
[17]
Emphysema and lung volume reduction surgery. — Caflisch AJ Journal of continuing education in nursing (2007)
[18]
Interobserver variability in the determination of upper lobe-predominant emphysema. — Hersh CP, Washko GR, Jacobson FL, Gill R, Estepar RS, Reilly JJ et al. Chest (2007)
[19]
Vitamin A and emphysema. — Baybutt RC, Molteni A Vitamins and hormones (2007)
[20]
Collateral ventilation. — Cetti EJ, Moore AJ, Geddes DM Thorax (2006)
[21]
Lung volume reduction surgery for emphysema: What the radiologist needs to know. — Screaton NJ, Reynolds JH Clinical radiology (2006)
[22]
Decompression of giant bulla in acute pneumonia: surgical palliation prior to definitive management. — Stewart NM, Saxena P, Newman MA, Konstantinov IE The Annals of thoracic surgery (2006)
[23]
Extensive surgical emphysema following restorative dental treatment. — Aquilina P, McKellar G Emergency medicine Australasia : EMA (2004)
[24]
Historical perspectives. — Cetindag IB, Hofmann PM, Hazelrigg SR Chest surgery clinics of North America (2003)
[25]
Methodological aspects of bronchoscopic lung volume reduction with a proprietary system. — Toma TP, Polkey MI, Goldstraw PG, Morgan C, Geddes DM Respiration; international review of thoracic diseases (2003)
[26]
Asymptomatic expectoration of surgical staples complicating lung volume reduction surgery. — Ahmed S, Marzouk KA, Bhuiya TA, Iqbal M, Rossoff LJ Chest (2001)
[27]
Bilateral subcutaneous emphysema of the orbits following nose blowing. — Mohan B, Singh KP The Journal of laryngology and otology (2001)
[28]
Morbidity and mortality related to the native lung in single lung transplantation for emphysema. — Mal H, Brugière O, Sleiman C, Rullon I, Jebrak G, Groussard O et al. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (2000)
[29]
Late-stage emphysema: when medical therapy fails. — Dasgupta A, Maurer J Cleveland Clinic journal of medicine (1999)
[30]
Imaging of patients with severe emphysema considered for lung volume reduction surgery. — Cleverley JR, Hansell DM The British journal of radiology (1999)
[31]
Permissive hypercapnia during thoracic anaesthesia. — Morisaki H, Serita R, Innami Y, Kotake Y, Takeda J Acta anaesthesiologica Scandinavica (1999)
[32]
Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla. — Bowler RP, Durham J, Schwarz MI Chest (1998)
[33]
Muscle-sparing anterior thoracotomy for one-stage bilateral lung volume reduction operation. — de Perrot M, Licker M, Spiliopoulos A The Annals of thoracic surgery (1998)
[34]
Management of the uncontrollable pulmonary air leak with cyanoacrylate glue. — Horsley WS, Miller JI The Annals of thoracic surgery (1997)
[35]
History of emphysema surgery. — Naef AP The Annals of thoracic surgery (1997)
[36]
Simultaneous single-lung transplantation and lung volume reduction. — Todd TR, Perron J, Winton TL, Keshavjee SH The Annals of thoracic surgery (1997)
[37]
Unilateral giant bullous emphysema with placental transmogrification of the lung. — Horsley WS, Gal AA, Mansour KA The Annals of thoracic surgery (1997)
[38]
"LIMA fissure" for a tension-free IMA graft in emphysema. — Rao PS, Natarajan KM, Morritt G The Annals of thoracic surgery (1997)
[39]
Serum alpha 1 antitrypsin and pulmonary emphysema. — Shahid A, Siddiqui AA, Aziz S, Ansari M, Zuberi SJ, Waqar MA JPMA. The Journal of the Pakistan Medical Association (1996)
[40]
Bullous emphysema: the role of the surgeon. — Briffa N, Vicidimini G, Braidley P, Nashef SA, Wells FC British journal of hospital medicine (1996)
[41]
Late contralateral lobectomy after single-lung transplantation for emphysema. — Le Pimpec-Barthes F, Debrosse D, Cuenod CA, Gandjbakhch I, Riquet M The Annals of thoracic surgery (1996)
[42]
Videothoracoscopic operations for bullous lung disease. — Jacques LF Chest surgery clinics of North America (1995)
[43]
Results of bullectomy. — Connolly JE Chest surgery clinics of North America (1995)
[44]
Lung reduction as bridge to lung transplantation in pulmonary emphysema. — Zenati M, Keenan RJ, Landreneau RJ, Paradis IL, Ferson PF, Griffith BP The Annals of thoracic surgery (1995)
[45]
Lung-volume reduction surgery for severe emphysema. — Cooper JD, Patterson GA Chest surgery clinics of North America (1995)
[46]
Lung transplantation for emphysema. — Patterson GA, Cooper JD Chest surgery clinics of North America (1995)
[47]
Congenital bilobar emphysema. — Hugosson C, Rabeeah A, Al-Rawaf A, Bakheet S, Banjar H Pediatric radiology (1995)
[48]
Evaluation of the emphysematous patient. — Dennie C, Coblentz CL, LeBlanc P Chest surgery clinics of North America (1995)
[49]
Unilateral thoracoscopic laser pneumoplasty of diffuse bullous emphysema. — Wakabayashi A Chest surgery clinics of North America (1995)
[50]
Anesthesia for patients undergoing surgery for emphysema. — Bussières JS Chest surgery clinics of North America (1995)
[51]
Emergent bullectomy in a patient with severe bullous emphysema receiving mechanical ventilatory assistance. — Pacht ER Chest (1995)
[52]
Let's treat body and mind. Collaborative rehabilitation for chronic breathlessness. — Heslop A, King M Professional nurse (London, England) (1994)
[53]
Management of bullous disease. — Deslauriers J, Leblanc P Chest surgery clinics of North America (1994)
[54]
CT measurement of mediastinal anterior junction line in emphysema patients. — Hagen G, Kolbenstvedt A Acta radiologica (Stockholm, Sweden : 1987) (1993)
[55]
Thoracoscopic intracavitary drainage for pneumothorax secondary to bullous emphysema. — Urschel JD, Dickout WJ Canadian journal of surgery. Journal canadien de chirurgie (1993)
[56]
Giant emphysematous bullae of the lung. — Ray D, Christopher DJ, Jairaj PS The Indian journal of chest diseases & allied sciences (1992)
[57]
Inspiratory spirogram in emphysema. — Meenakshi S, Gajalakshmi BS Journal of the Indian Medical Association (1992)
[58]
Pulmonary emphysema in a nonsmoker with normal alpha-1-antitrypsin. — Habenstein KR, Roy TM, Fields CL The Journal of the Kentucky Medical Association (1992)
[59]
Alpha 1-antitrypsin deficiency: pathogenesis and treatment. — Crystal RG Hospital practice (Office ed.) (1991)
[60]
Contralateral pneumonectomy after single-lung transplantation for emphysema. — Novick RJ, Menkis AH, Sandler D, Garg A, Ahmad D, Williams S et al. The Annals of thoracic surgery (1991)
[61]
Three cases of alpha-1-antitrypsin deficiency in the elderly. — Jack CI, Evans CC Postgraduate medical journal (1991)
[62]
Discovery of alpha 1-antitrypsin deficiency. — Eriksson S Lung (1990)
[63]
The protease-antiprotease balance within the human lung: implications for the pathogenesis of emphysema. — Gadek JE, Pacht ER Lung (1990)
[64]
Tsk mice with genetic emphysema. Right ventricular hypertrophy occurs without hypertrophy of muscular pulmonary arteries or muscularization of arterioles. — Martorana PA, Wilkinson M, van Even P, Lungarella G The American review of respiratory disease (1990)
[65]
Assessment of lung parenchymal destruction by using routine histologic tissue sections. — Nagai A, Yamawaki I, Thurlbeck WM, Takizawa T The American review of respiratory disease (1989)
[66]
Multifocal bullous emphysema with concurrent bronchial hypoplasia in two aged Afghan hounds. — Anderson WI, King JM, Flint TJ Journal of comparative pathology (1989)
[67]
Reversible hyperinflation in emphysema. — Hertz MI, Bonser RS, Jamieson SW, Tashjian J, Halvorsen RA Chest (1989)
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