Although the exact mechanism is still not fully understood.

End stage emphysema is a disabling disease associated with high morbidity, mortality and poor quality of life. Medical treatment

limited effectiveness, since it can not resolve anatomical abnormalities that cause physical and pathological changes

seen in emphysema. Emphysema, essentially due to the destruction of elastic tissue. Loss of elastic recoil results in exhaled

airway obstruction and premature closure of peripheral airways due to decreased airway radial forces stretching. Air capture >> << hyperinflation and progressive to make a significant impact on ventilation and functional muscle strength airways. Air Flow

limitation can be improved by lasix furosemide side effects resection of poorly functioning lung parenchyma, such as is done with bullectomy

or decrease the volume of the lungs. Disabling breathlessness is the most common indication for surgery. Bullectomy is a well

procedure that in some patients can significantly improve symptoms, exercise tolerance and respiratory reserves and eventually

complications. In patients with end-stage emphysema, blisters may be part of generalized disease (stage III de Vries and Wolf classification)

and well accepted that this presentation of emphysema should be separated from bullae associated with normal or

almost normal primary parenchyma (stage IBЂ "II De Vries and Wolf classification). Some reports claimed that bullectomy

in patients with severe generalized emphysema key is not necessary, and is associated with a higher rate of morbidity and mortality

and found these long-term more rapid deterioration than in patients with localized disease. This functional decline seems to be the same as recorded after LVR. We believe that the positive effect >> << bullectomy in patients with end-stage emphysema is mainly due to decline in lung and restoration of diaphragmatic and chest wall

mechanics, and not easily re-expansion and hiring the best functional lung tissue. Generally, improvement in

FEV and DLCO, usually modest, RV and TLC usually decreases. These observations are similar to those observed when the amount of light

reduction in non-bullous emphysema, and confirm the theory of Snyder

bullectomy, that patients with severe emphysema is BЂњa special case of pulmonary reductionBЂ ". Bullectomy and reduction of lung and allows removal of excess space occupied by little functional lung tissue and

improvement observed after surgery may be significantly lower due to RV and thoracic hyperinflation, re-expansion of adjacent better functioning lung tissue, increasing the strength of respiratory muscles, chest mechanics

inside the chest hemodynamics. Bull in this subgroup of patients can be interpreted as a sign of heterogeneous emphysema that is associated with the same

favorable clinical results after LVR. Reducing the volume and yield reduction as bullectomy RV that was plethysmographically

defined. In contrast, R. estimated dilution of helium does not change. In other words, both procedures allow

place is air capture light for resection. Reduction of RV positive effect on TLC and had residual >> << capacity (FRC). Improved muscle strength was clearly demonstrated after bullectomy and pneumoplasty

BЂ. " This effect is associated with restoration of diaphragmatic curvature and morphology of the chest wall. Re-expansion related

compressed light leads to a set of major airways, blood vessels and alveoli. This seems to indicates an increase in

FEV / FVC ratio is only slightly changed. Improved dynamic expiratory rate can be explained by the increase >> << elastic recoil pressure well demonstrated after LVR

and bullectomy. In conclusion, our experience and numerous reports in the literature, confirming the hypothesis that the physical and pathological basis

improvement after lung volume reduction and resection of bullae in patients with end-stage emphysema seems to be the same as

Although the exact mechanism is still not fully understood. The consequences of the operation of gas exchange and intrathoracic hemodynamics

should be studied in more detail, as well as long-term changes. . << >>