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Long-term follow-up after bronchoscopic lung volume reduction treatment with coils in patients with severe emphysema.

Hartman JE, Klooster K, Gortzak K, ten Hacken NH, Slebos DJ - Respirology (2014)

Bottom Line: At 1-year follow-up, all clinical outcomes significantly improved compared with baseline.Follow-up of the patients treated with LVR-coils in our pilot studies showed that the coil treatment is safe with no late pneumothoraces, coil migrations or unexpected adverse events.Clinical benefit gradually declines over time; at 3 years post-treatment, around 50% of the patients maintained improvement in 6MWD, SGRQ and mMRC.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

No MeSH data available.


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Histology of transplanted lungs of two patients (photomicrograph, haematoxylin and eosin stain). (a) Low power magnification of lung tissue demonstrating two device imprints (arrows) in the alveolar parenchyma. (b) Higher magnification of the boxed area in image (a) demonstrating the two device imprints in tissue. At this magnification, it is evident that there is a thin, compressed capsule of tissue around the imprints with no other significant inflammatory reaction present. This image also demonstrates the presence of interstitial fibrosis of alveolar septa along the left hand side of the image. (c) Higher magnification of the boxed area in image (b) demonstrating a closer view of the device capsule and the surrounding alveolar parenchyma. (d) Low power magnification of a single device imprint in the alveolar parenchyma (arrow). The imprint is surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma. Pre-existing emphysema (enlarged alveolar spaces) is also evident in this image. (e) Low power magnification of a single device imprint (arrow) in the alveolar parenchyma adjacent to a pulmonary vein. (f) Low power magnification of a single device imprint in an area of more dense fibrous tissue. The device capsule contains a mild degree of inflammation. (a–c) Patient 1 year after LVR-coil treatment; (d–f) patient 4 years after LVR-coil treatment.
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fig04: Histology of transplanted lungs of two patients (photomicrograph, haematoxylin and eosin stain). (a) Low power magnification of lung tissue demonstrating two device imprints (arrows) in the alveolar parenchyma. (b) Higher magnification of the boxed area in image (a) demonstrating the two device imprints in tissue. At this magnification, it is evident that there is a thin, compressed capsule of tissue around the imprints with no other significant inflammatory reaction present. This image also demonstrates the presence of interstitial fibrosis of alveolar septa along the left hand side of the image. (c) Higher magnification of the boxed area in image (b) demonstrating a closer view of the device capsule and the surrounding alveolar parenchyma. (d) Low power magnification of a single device imprint in the alveolar parenchyma (arrow). The imprint is surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma. Pre-existing emphysema (enlarged alveolar spaces) is also evident in this image. (e) Low power magnification of a single device imprint (arrow) in the alveolar parenchyma adjacent to a pulmonary vein. (f) Low power magnification of a single device imprint in an area of more dense fibrous tissue. The device capsule contains a mild degree of inflammation. (a–c) Patient 1 year after LVR-coil treatment; (d–f) patient 4 years after LVR-coil treatment.

Mentions: On gross macroscopic evaluation of the lung explants, the coils could be identified in the main segmental and sub-segmental airways. No vascular disruptions were noticed, nor were there any abscess formations in the coiled regions. Histopathological examination revealed in both patients, besides presence of emphysematous tissue, a thin, compressed capsule of tissue around the imprints of the airways with a slight inflammatory reaction. It was unclear whether these changes represent pre-existing pathology in these patients or if this is associated with device placement. In the 1-year specimen, the presence of interstitial fibrosis of alveolar septa with the device ‘capsule’ and the surrounding alveolar parenchyma was visible. In the 4-year specimen, the device imprint in the airways was surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma, and this was also found in the alveolar parenchyma, where the device imprint was in an area of more dense fibrous tissue. No abundant inflammatory reaction or infection was found in either explant (see Fig. 4a–f).


Long-term follow-up after bronchoscopic lung volume reduction treatment with coils in patients with severe emphysema.

Hartman JE, Klooster K, Gortzak K, ten Hacken NH, Slebos DJ - Respirology (2014)

Histology of transplanted lungs of two patients (photomicrograph, haematoxylin and eosin stain). (a) Low power magnification of lung tissue demonstrating two device imprints (arrows) in the alveolar parenchyma. (b) Higher magnification of the boxed area in image (a) demonstrating the two device imprints in tissue. At this magnification, it is evident that there is a thin, compressed capsule of tissue around the imprints with no other significant inflammatory reaction present. This image also demonstrates the presence of interstitial fibrosis of alveolar septa along the left hand side of the image. (c) Higher magnification of the boxed area in image (b) demonstrating a closer view of the device capsule and the surrounding alveolar parenchyma. (d) Low power magnification of a single device imprint in the alveolar parenchyma (arrow). The imprint is surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma. Pre-existing emphysema (enlarged alveolar spaces) is also evident in this image. (e) Low power magnification of a single device imprint (arrow) in the alveolar parenchyma adjacent to a pulmonary vein. (f) Low power magnification of a single device imprint in an area of more dense fibrous tissue. The device capsule contains a mild degree of inflammation. (a–c) Patient 1 year after LVR-coil treatment; (d–f) patient 4 years after LVR-coil treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4321042&req=5

fig04: Histology of transplanted lungs of two patients (photomicrograph, haematoxylin and eosin stain). (a) Low power magnification of lung tissue demonstrating two device imprints (arrows) in the alveolar parenchyma. (b) Higher magnification of the boxed area in image (a) demonstrating the two device imprints in tissue. At this magnification, it is evident that there is a thin, compressed capsule of tissue around the imprints with no other significant inflammatory reaction present. This image also demonstrates the presence of interstitial fibrosis of alveolar septa along the left hand side of the image. (c) Higher magnification of the boxed area in image (b) demonstrating a closer view of the device capsule and the surrounding alveolar parenchyma. (d) Low power magnification of a single device imprint in the alveolar parenchyma (arrow). The imprint is surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma. Pre-existing emphysema (enlarged alveolar spaces) is also evident in this image. (e) Low power magnification of a single device imprint (arrow) in the alveolar parenchyma adjacent to a pulmonary vein. (f) Low power magnification of a single device imprint in an area of more dense fibrous tissue. The device capsule contains a mild degree of inflammation. (a–c) Patient 1 year after LVR-coil treatment; (d–f) patient 4 years after LVR-coil treatment.
Mentions: On gross macroscopic evaluation of the lung explants, the coils could be identified in the main segmental and sub-segmental airways. No vascular disruptions were noticed, nor were there any abscess formations in the coiled regions. Histopathological examination revealed in both patients, besides presence of emphysematous tissue, a thin, compressed capsule of tissue around the imprints of the airways with a slight inflammatory reaction. It was unclear whether these changes represent pre-existing pathology in these patients or if this is associated with device placement. In the 1-year specimen, the presence of interstitial fibrosis of alveolar septa with the device ‘capsule’ and the surrounding alveolar parenchyma was visible. In the 4-year specimen, the device imprint in the airways was surrounded by a well-organized fibrous capsule comprised of compressed, concentric rings of stroma, and this was also found in the alveolar parenchyma, where the device imprint was in an area of more dense fibrous tissue. No abundant inflammatory reaction or infection was found in either explant (see Fig. 4a–f).

Bottom Line: At 1-year follow-up, all clinical outcomes significantly improved compared with baseline.Follow-up of the patients treated with LVR-coils in our pilot studies showed that the coil treatment is safe with no late pneumothoraces, coil migrations or unexpected adverse events.Clinical benefit gradually declines over time; at 3 years post-treatment, around 50% of the patients maintained improvement in 6MWD, SGRQ and mMRC.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

No MeSH data available.


Related in: MedlinePlus