| Popis: |
Emphysema is a common and disabling lung disease. It is not necessarily generalised in distribution but frequently appears to be predominant in the apices or in the bases. A recently developed physiological method using a radioactive gas has made possible the study of regional lung function and well established techniques are available for assessing the overall distribution and exchange of respiratory gases. These, coupled with careful clinical and radiological methods have been used in this study to identify and assess the effect of localised and generalised pulmonary emphysema. Comparison of these methods of examination in a number of patients suffering from emphysema comprises the main subject matter of this thesis. It is hoped that observations made in this way will assist the physician to a better understanding of the different forms of the disease and the resulting functional effect. Chronic bronchitis cannot be ignored in this study as it frequently complicates emphysema or is complicated by it. The functional effects of bronchitis, like emphysema, are severe airways obstruction and an impairment of gas exchange within the lung. At present there is no radiological or clinical evidence that the effects of bronchitis are localised. It is difficult with present techniques to separate the effects' of emphysema from bronchitis when the two diseases occur together. Therefore, I have tried to evaluate regional and overall lung function in selected cases where there is bronchitis but no evidence of emphysema and emphysema but no bronchitis. By comparing the two groups I hoped to find the functional effects of these diseases separately. As the aetiology of emphysema is unknown and the nature of the lesion destructive, physicians can only observe and try to prevent complicating infection. In some cases evident localisation of the disease attracts the possibility of surgical intervention. Removal or plication of the affected lung are procedures which are undertaken in this type of case. The criteria for selection of patients, the rationale of the venture and the outcome have not been established, I intend to consider these problems in the light of the results of studies done on a few patients before and after operation. As there are several different aspects of this study each will be considered in a separate chapter with presentation of the relevant results and discussion. |
