SPENCER FOREMAN, M.D.; HANS WEILL, M.D., F.A.C.P.; ROY DUKE, M.D.; RONALD GEORGE, M.D.; MORTON ZISKIND, M.D., F.A.C.P.
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Thirteen patients with enlarging symptomatic bullae had pre- and postoperative clinical, radiographic, radioisotope lung scanning and physiologic evaluation. Resected bullae occupied at least one half of one hemithorax on the chest X ray. Before surgery there was generally reduction of communicating total lung capacity (TLC) with more marked reduction of the forced expiration volume for 1 sec (FEV1). Residual volume was increased. Hypoxemia was common, and hypercapnia occurred in three patients before surgery. There was usually reduction of pulmonary diffusing capacity, and lung radioscans showed absence of perfusion in the bullous zones. After surgery, good perfusion was demonstrated in the reexpanded segments of all patients except one who did not improve clinically and who had reduced counts over the underlying lung in the preoperative perfusion scan. Increase of the communicating TLC (5 out of 6) and FEV1 (9 out of 11) was associated with improved oxygenation (6 out of 7) and alveolar ventilation (in all 3 patients who had an elevated carbon dioxide pressure (PCO2)) after surgery. The usual result was marked symptomatic improvement.
FOREMAN S, WEILL H, DUKE R, GEORGE R, ZISKIND M. Bullous Disease of the Lung: Physiologic Improvement After Surgery. Ann Intern Med. ;69:757–767. doi: 10.7326/0003-4819-69-4-757
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Published: Ann Intern Med. 1968;69(4):757-767.
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