OBJECTIVE: Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation. METHODS: Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative-postoperative FEV(1) change (DeltaFEV(1)). RESULTS: No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1. 05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal DeltaFEV(1), ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group DeltaFEV(1) was greater in patients with ARE>/=1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group DeltaFEV(1) was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0. 03). No difference was found when comparing DeltaFEV(1) resulting from unilateral RP and ARE>/=1.3, and bilateral RP (0.44 vs. 0.41 l, not significant). CONCLUSIONS: This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach

Pompeo, E., Sergiacomi, G., Nofroni, I., Roscetti, W., Simonetti, G., Mineo, T.c. (2000). Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 17(6), 680-686 [10.1016/S1010-7940(00)00441-3].

Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty

POMPEO, EUGENIO;SERGIACOMI, GIANLUIGI;SIMONETTI, GIOVANNI MARIA EGISTO;MINEO, TOMMASO CLAUDIO
2000-06-01

Abstract

OBJECTIVE: Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation. METHODS: Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative-postoperative FEV(1) change (DeltaFEV(1)). RESULTS: No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1. 05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal DeltaFEV(1), ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group DeltaFEV(1) was greater in patients with ARE>/=1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group DeltaFEV(1) was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0. 03). No difference was found when comparing DeltaFEV(1) resulting from unilateral RP and ARE>/=1.3, and bilateral RP (0.44 vs. 0.41 l, not significant). CONCLUSIONS: This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach
giu-2000
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/21 - CHIRURGIA TORACICA
English
Con Impact Factor ISI
Sensitivity and Specificity; Respiratory Function Tests; Severity of Illness Index; Odds Ratio; Reproducibility of Results; Humans; Tomography, X-Ray Computed; Retrospective Studies; Aged; Predictive Value of Tests; Patient Selection; Pulmonary Emphysema; Pneumonectomy; Logistic Models; Adult; Treatment Outcome; Middle Aged; Female; Male
Pompeo, E., Sergiacomi, G., Nofroni, I., Roscetti, W., Simonetti, G., Mineo, T.c. (2000). Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 17(6), 680-686 [10.1016/S1010-7940(00)00441-3].
Pompeo, E; Sergiacomi, G; Nofroni, I; Roscetti, W; Simonetti, Gme; Mineo, Tc
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/67097
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