scholarly journals Computed Tomography and Spirometry Can Predict Unresectability in Malignant Pleural Mesothelioma

2021 ◽  
Vol 10 (19) ◽  
pp. 4407
Author(s):  
Alice Bellini ◽  
Andrea Dell’Amore ◽  
Chiara Giraudo ◽  
Antonella Modugno ◽  
Nicol Bernardinello ◽  
...  

Preoperative identification of unresectable pleural mesothelioma could spare unnecessary surgical intervention and accelerate the initiation of medical treatments. The aim of this study is to determine predictors of unresectability, testing our impression that the contraction of the ipsilateral hemithorax is often associated with exploratory thoracotomy. Between 1994 and 2020, 291 patients undergoing intended macroscopic complete resection for mesothelioma after chemotherapy were retrospectively investigated. Eligible patients (n = 58) presented a preoperative 3 mm slice-thickness chest computed tomography without pleural effusion or hydropneumothorax. Lung volumes (segmented using a semi-automated method), modified-Response Evaluation Criteria in Solid Tumors (RECIST) measurements, and spirometries were collected after chemotherapy. Multivariable analysis was performed to determine the predictors of unresectability. An unresectable disease was found at the time of operation in 25.9% cases. By multivariable analysis, the total lung capacity (p = 0.03) and the disease burden (p = 0.02) were found to be predictors of unresectability; cut-off values were <77.5% and >120.5 mm, respectively. Lung volumes were not confirmed to be associated with unresectability at multivariable analysis, probably due to the correlation with the disease burden (p < 0.001; r = −0.4). Our study suggests that disease burden and total lung capacity could predict MPM unresectability, helping surgeons in recommending surgery or not in a multimodality setting.

PEDIATRICS ◽  
1959 ◽  
Vol 24 (2) ◽  
pp. 181-193
Author(s):  
C. D. Cook ◽  
P. J. Helliesen ◽  
L. Kulczycki ◽  
H. Barrie ◽  
L. Friedlander ◽  
...  

Tidal volume, respiratory rate and lung volumes have been measured in 64 patients with cystic fibrosis of the pancreas while lung compliance and resistance were measured in 42 of these. Serial studies of lung volumes were done in 43. Tidal volume was reduced and the respiratory rate increased only in the most severely ill patients. Excluding the three patients with lobectomies, residual volume and functional residual capacity were found to be significantly increased in 46 and 21%, respectively. These changes correlated well with the roentgenographic evaluation of emphysema. Vital capacity was significantly reduced in 34% while total lung capacity was, on the average, relatively unchanged. Seventy per cent of the 61 patients had a signficantly elevated RV/TLC ratio. Lung compliance was significantly reduced in only the most severely ill patients but resistance was significantly increased in 35% of the patients studied. The serial studies of lung volumes showed no consistent trends among the groups of patients in the period between studies. However, 10% of the surviving patients showed evidence of significant improvement while 15% deteriorated. [See Fig. 8. in Source Pdf.] Although there were individual discrepancies, there was a definite correlation between the clinical evaluation and tests of respiratory function, especially the changes in residual volume, the vital capacity, RV/ TLC ratio and the lung compliance and resistance.


1978 ◽  
Vol 45 (6) ◽  
pp. 957-961 ◽  
Author(s):  
J. M. Drazen ◽  
S. H. Loring ◽  
C. Venugopalan

The effects of intravenous antigen infusion on lung volumes and quasi-static deflationary pulmonary compliance in guinea pigs previously sensitized to ovalbumin were studied in vivo. Ovalbumin infusion significantly increased minimal gas volume to a similar extent in animals with intact or cut vagi. Total lung capacity fell only in animals with intact vagi. Quasi-static compliance fell in both groups of animals, but the fall was significantly greater in animals with intact vagi. These data demonstrate that immediate hypersensitivity reactions alter lung volumes and the elastic properties of the lung by both vagal dependent and vagal independent mechanisms.


1961 ◽  
Vol 16 (2) ◽  
pp. 331-338 ◽  
Author(s):  
C. Emirgil ◽  
H. O. Heinemann

Fifteen patients, free from cardiac and pulmonary disease, but receiving radiotherapy for carcinoma of the breast or carcinoma of the lung, were studied to determine the effect of irradiation on pulmonary function. Lung volumes, the distribution of inspired air, the levels of gases in the arterial blood, the diffusing capacity of the lung, and the mechanics of breathing were measured before and at varying intervals after the completion of radiotherapy. The results showed: early and progressive reduction of inspiratory capacity (IC) and residual volume (RV), decreasing the total lung capacity (TLC) without changing the RV/TLC ratio; unchanged distribution of inspired air; mild hypoxemia at rest; reduced diffusing capacity of the lung for carbon monoxide; and an early and progressive decrease in pulmonary compliance. These observations indicate that irradiation of the chest is complicated by a decrease in lung volumes, an impairment of the diffusing capacity, and an increase in the work of breathing. Submitted on September 6, 1960


1993 ◽  
Vol 36 (3) ◽  
pp. 516-520 ◽  
Author(s):  
Jeannette D. Hoit ◽  
Nancy Pearl Solomon ◽  
Thomas J. Hixon

This investigation was designed to test the hypothesis that voice onset time (VOT) varies as a function of lung volume. Recordings were made of five men as they repeated a phrase containing stressed /pi/ syllables, beginning at total lung capacity and ending at residual volume. VOT was found to be longer at high lung volumes and shorter at low lung volumes in most cases. This finding points out the need to take lung volume into account when using VOT as an index of laryngeal behavior in both healthy individuals and those with speech disorders.


2016 ◽  
Vol 57 (4) ◽  
pp. 963 ◽  
Author(s):  
Sung Ho Hwang ◽  
Jin Gu Lee ◽  
Tae Hoon Kim ◽  
Hyo Chae Paik ◽  
Chul Hwan Park ◽  
...  

1994 ◽  
Vol 77 (2) ◽  
pp. 963-973 ◽  
Author(s):  
D. D. Marciniuk ◽  
G. Sridhar ◽  
R. E. Clemens ◽  
T. A. Zintel ◽  
C. G. Gallagher

Lung volumes were measured at rest and during exercise by an open-circuit N2-washout technique in patients with interstitial lung disease (ILD). Exercise tidal flow-volume (F-V) curves were also compared with maximal F-V curves to investigate whether these patients demonstrated flow limitation. Seven patients underwent 4 min of constant work rate bicycle ergometer exercise at 40, 70, and 90% of their previously determined maximal work rates. End-expiratory lung volume and total lung capacity were measured at rest and near the end of each period of exercise. There was no significant change in end-expiratory lung volume or total lung capacity when resting measurements were compared with measurements at 40, 70, and 90% work rates. During exercise, expiratory flow limitation was evident in four patients who reported stopping exercise because of dyspnea. In the remaining patients who discontinued exercise because of leg fatigue, no flow limitation was evident. In all patients, the mean ratio of maximal minute ventilation to maximal ventilatory capacity (calculated from maximal F-V curves) was 67%. We conclude that lung volumes during exercise do not significantly differ from those at rest in this population and that patients with ILD may demonstrate expiratory flow limitation during exercise. Furthermore, because most patients with ILD are not breathing near their maximal ventilatory capacity at the end of exercise, we suggest that respiratory mechanics are not the primary cause of their exercise limitation.


1962 ◽  
Vol 17 (5) ◽  
pp. 783-786 ◽  
Author(s):  
John S. Hanson ◽  
Burton S. Tabakin ◽  
Edgar J. Caldwell

Variations in size of the various lung volumes due to changes in body position and as a consequence of treadmill exercise were studied in five normal males. Assumption of the upright posture was associated with highly significant increases in total lung capacity, vital capacity, expiratory reserve volume, and residual volume as compared to resting supine values. Level walking was associated with a decrease of expiratory reserve volume, but a further expansion of residual volume. Vital capacity decreased slightly, but total lung capacity increased by virtue of the proportionately large residual volume increases. Elevation of the treadmill to 4° resulted in slight decreases in all lung volumes, total lung capacity evidencing a barely significant decline. Positional changes in ventilation are described, and on the basis of the “lung clearance index” an increased efficiency of ventilation is seen in the upright posture. Factors possibly operative in these alterations are discussed. Submitted on February 21, 1962


1980 ◽  
Vol 49 (4) ◽  
pp. 558-565 ◽  
Author(s):  
N. Berend ◽  
C. Skoog ◽  
W. M. Thurlbeck

Static deflationary pressure-volume curves were obtained in 28 emphysema-free (18 male and 10 female) and 39 emphysematous excised human lungs inflated to a maximum transpulmonary pressure (Pl) of 30 cmH2O. In emphysema-free lungs, the lung volumes at Pl 30 cmH2O (V30) were significantly related to body length in males and were significantly larger than predicated total lung capacity in vivo. However, corrected for stature (V30/body length), there was no significant age correlation. In both males and females, highly significant correlations between the PL at 50--90% V30 and age were obtained. There were no significant differences in these regressions between males and females. The emphysematous lungs were divided into three groups with increasing emphysema grades. Progressive decreases in the PL at 50--90% V30 and increases in the V30 were seen in the groups with increasing degrees of emphysema. Significant changes occurred in these measurements even in group 2 with mild emphysema, suggesting that the lesions of emphysema are not directly responsible for these changes.


2001 ◽  
Vol 90 (6) ◽  
pp. 2088-2093 ◽  
Author(s):  
Theodore A. Wilson ◽  
Ron C. Anafi ◽  
Rolf D. Hubmayr

Using the parenchymal marker technique, we measured pressure (P)-volume (P-V) curves of regions with volumes of ∼1 cm3 in the dependent caudal lobes of oleic acid-injured dog lungs, during a very slow inflation from P = 0 to P = 30 cmH2O. The regional P-V curves are strongly sigmoidal. Regional volume, as a fraction of volume at total lung capacity, remains constant at 0.4–0.5 for airway P values from 0 to ∼20 cmH2O and then increases rapidly, but continuously, to 1 at P = ∼25 cmH2O. A model of parenchymal mechanics was modified to include the effects of elevated surface tension and fluid in the alveolar spaces. P-V curves calculated from the model are similar to the measured P-V curves. At lower lung volumes, P increases rapidly with lung volume as the air-fluid interface penetrates the mouth of the alveolus. At a value of P = ∼20 cmH2O, the air-fluid interface is inside the alveolus and the lung is compliant, like an air-filled lung with constant surface tension. We conclude that the properties of the P-V curve of edematous lungs, particularly the knee in the P-V curve, are the result of the mechanics of parenchyma with constant surface tension and partially fluid-filled alveoli, not the result of abrupt opening of airways or atelectatic parenchyma.


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