الفهرس 
o Chronic obstructive pulmonary diseaseOnly 14 pages are availabe for public view
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Abstract
Chronic Obstructive Pulmonary Disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. (125)
Emphysema is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis. Emphysema, or destruction of the gas exchanging surfaces of the lung (alveoli), is a pathological term that is often (but incorrectly) used clinically and describes only one of several structural abnormalities present in patients with COPD. (126)
Lung volume reduction surgery (LVRS) is a surgical procedure performed to remove diseased, emphysematous lung tissue. Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work better.
Impulse oscillometry is a noninvasive, rapid, safe and validated technique that measures respiratory impedance that is used as an indicator of lung function.
This is the first study to use a biological material (histoacrayl) and to use the IOS as a tool to measure the P.F.T after bronchoscopic lung volume reduction. The current study was conducted at Kobri El-koba Military Hospital from July, 2014 to April, 2015 to to assess of the lung function using impulse oscillometry before and after bronchoscopic lung volume reduction using histoacrayl. Thirty male patients included in this study from July, 2014.Their age ranging from 35 to 68 with mean age 62 years old (± 7.7), with a smoking index of (435± 55) pack/year. The most common co-morbidity was IHD 3(10%).The patients were divided in 2 groups: group A: diffuse emphysema (n=23 patients) and group B: emphysematous bullae (n=7 patients). In the present study, 13 (43.3%) had pulmonary nodules after injected by histoacrayl glue.
All patients were subjected to the following before and three months after bronchoscopy:
1. Thorough history taking and clinical examination.
2. Laboratory investigation was done before bronchoscope:
.Complete blood count (CBC).
.Liver function tests. (SGPT, SGOT, HCV and HBV)
.PT, PTT and INR.
3. Arterial blood gases (ABG).
4. Electrocardiograph (ECG).
5. Chest X ray was done for every patient to recognize roughly the size and site of the bulla or emphysema.
6. Then high resolution CT chest was done as it is more sensitive than chest x ray to detect bullae number, size and position and its feeding bronchi in which BLVR should be applied.
7. Spirometric lung functions. (The cardiotouch 3000 boint).
8. Impulse oscillometry (IOS) was performed using commercially available IOS unit (Jaeger GmbH, Germany). Airway resistance at 5 Hz (R5) & 20 Hz (R20), as well as reactance at 5 Hz (X5) will be calculated.
9. F.O.B
Results revealed that there was no changes as regards the radiological findings pre and post procedure except for 13 (43.3%) patients who developed pulmonary nodules post procedure detected by HR-CT.
There was significant statistical difference after the procedure as regards 6 min walk test.
Dyspnea score had improved but with no statistically significant difference before and after the procedure.
There was statistically significant difference as regards the FVC p-< 0.005, p-< 0.002 in two groups (Diffuse emphysema and emphysematous bullae group), FEV1 p-< 0.001 only in emphysematous bullae group improved post the procedure.
There was statistically significant difference as regards the R5 p-< 0.005, p-< 0.025 and R20 p-< 0.034, p-< 0.001 in two groups, (diffuse emphysema and emphysematous bullae group), improved post the procedure.
There was a highly statistically significant difference as regards the PaO2 p-< 0.0006 improved post the procedure. However, there was no significant statistical difference as regards PH, PaCO2, HCO3 and SO2 after the procedure.
There was mild to moderate negative correlations between FVC and R5 in diffuse emphysema group only (n=23), rho (-0.47), p-value (0.025).However, there was strong positive correlation between FEV1 and X5 in emphysematous bullae group (n=7), rho (0.82), p-value (0.023).
There was statistically significant difference as regards change in R20, X5 and PaO2 and 6-MWD (% of pre-procedure value) in emphysematous bullae (n=7) more than diffuse emphysema / hyperinflation (n=23) were improved after the procedure. However, there was no statistically significant difference on other parameters.