الفهرس 
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Abstract
Emphysema is one of the most common chronic and progressive conditions associated with COPD. It is defined pathologically as a destruction of the lung parenchyma due to chronic inflammation, followed by the permanent enlargement of the terminal bronchioles, dynamic hyperinflation, and loss of elastic recoil, air trapping leading to reduction in exercise capacity. Biological lung volume reduction (BioLVR) is a new endobronchial therapy for emphysema using biological agents, as biodegradable substances, blood patches and fibrin glues to achieve lung volume reduction. The fast acting polymerizing sealant, acts at the alveolar level rather than in the airways, leading to resorption atelectasis from airway occlusion with subsequent airspace inflammation and finally remodeling, that leads to scarring and contraction of lung parenchyma, and functional lung volume reduction can be expected to occur within six to eight weeks. This study describes the potential safety and efficacy of bronchoscopic (BioLVR) (fibrinogen and thrombin) therapy in advanced homogenous emphysema. This study was carried out on 40 male COPD patients with homogenous emphysema All selected patients were subjected to the following basic evaluation: History taking, physical examination, CXR, complete blood count (CBC), prothrombin time(PT), partial thromboplastin time (PTT), international normalized ratio (INR), electrocardiogragraphy (ECG), arterial blood gases (ABG), liver and kidney function tests. The following evaluating parameters were done on admission as a basic value, then at 1,3,6 month post procedure: Multidetector CT chest (HRCT volumetry), pulmonary function tests (spirometry; FEV1 , FVC, FEV1 / FVC, and lung volumes; RV, TLC, RV/TLC using single breath helium dilution method), 6-minute walk distance (6MWD), mMRC dyspnea scale, COPD Assessment Test (CAT) score for quality of life assessment. HRCT volumetry was done using 128 multidetector CT scanner (Philips Ingenuity Core128 scanner, Philips Medical Systems, Best, the Netherlands) and included both helical CT and HRCT. Results: Matching criteria: • The mean age of patients was 58.40 ± 6.86 years. • Smoking index range of the X smokers patients was (20-100) with Mean ± SD(51.35 ± 22.56). Efficacy results: • There was statistically significant reduction in HRCT volumetry at 1st ,3rd ,6th month (p value=0.001) from baseline. • There was statistical significant reduction in RV/TLC at 1st ,3rd ,6th month (p value=0.001) from baseline. • There was statistically significant improvement in mMRC dyspnea scale at 1,3,6 month (p value=0.001), CAT score and 6MWT from baseline. • Regarding spirometric measures, FEV1 and FEV1/FVC% significantly increased at 1,3,6 month follow up time. Safety results: All patients tolerated the procedure without significant problems. There was no serious procedural or immediate postprocedural complications. In this study pneumonia occurred in one patient at the same side of intervention 7 days postprocedure (0.025%), which improved after 10 days of inpatient treatment and three cases developed COPD excerpation (0.075%), which developed 3 days postprocedure and was controlled by medical therapy. No serious complications had been occurred e.g. (pneumothorax, pulmonary embolism, myocardial infarction or cardiac ischemia).