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Management of post-pneumonectomy syndrome using tissue expanders.

ABSTRACT: Post-pneumonectomy syndrome (PPS) is a rare syndrome characterized by trachea-bronchial stenosis and severe dyspnea. In this study, we retrospectively evaluated the clinical outcomes in patients who underwent placement of tissue expanders for PPS.Data from patients who underwent placement of tissue expanders for PPS were analyzed for preoperative characteristics, surgical techniques, and postoperative outcomes. Between 1997 and 2014, a total of 10 patients were treated for PPS by tissue expanders.The median age of the 10 patients was 45 years (range, 16-70). Four patients had undergone right pneumonectomy, three patients had undergone left pneumonectomy, and three patients had post-pneumonectomy-like syndrome. Preoperatively, seven patients initially received high oxygen therapy for hypoxemia but progressed to respiratory failure, and three patients required mechanical ventilator support. Among these three patients, one required intraoperative extracorporeal membrane oxygenation support because of sudden cardiac arrest during preparation for surgery. The median follow-up was 59.5 months (range, 2-204). The median interval between pneumonectomy and repositioning was 13 months (range, 8-581). Two patients underwent placement of a single tissue expander, and two tissue expanders were placed in eight of the 10 patients. The median volume of tissue expanders inflated with saline was 450 cc (range, 60-850 cc) per tissue expander. There was no perioperative mortality in our study. Complications occurred in four patients (40%).Repositioning of the mediastinum with placement of a saline filled tissue expander for PPS is very effective for the relief of symptoms, with low mortality.

SUBMITTER: Jung JJ

PROVIDER: S-EPMC4718120 | biostudies-other | 2016 Jan

REPOSITORIES: biostudies-other

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Project description:The adult human lung has a very limited capacity to regenerate functional alveoli. In contrast, adult mice have a remarkable capacity for neoalveolarization following either lung resection or injury. The molecular basis for this unique capability to regenerate lung tissue in mice is largely unknown. We examined the transcriptomic responses to single lung pneumonectomy in adult mice in order to elucidate prospective molecular signaling used in this species during lung regeneration. Unilateral left pneumonectomy or sham thoracotomy was performed under general anesthesia (n = 8 mice per group for each of the four time points). Total RNA was isolated from the remaining lung tissue at four time points post-surgery (6 hours, 1 day, 3 days, 7 days) and analyzed using microarray technology. The observed transcriptomic patterns revealed mesenchymal cell signaling, including up-regulation of genes previously associated with activated fibroblasts (Tnfrsf12a, Tnc, Eln, Col3A1), as well as modulation of Igf1-mediated signaling. The data set also revealed early down-regulation of pro-inflammatory cytokine transcripts, up-regulation of genes involved in T cell development and function, but few similarities to transcriptomic patterns observed during embryonic or post-natal lung development. Immunohistochemical analysis suggests that early fibroblast but not myofibroblast proliferation is important during lung regeneration and may explain the preponderance of mesenchymal-associated genes that are over-expressed in this model. This appears to differ from embryonic alveologenesis. These data suggest that modulation of mesenchymal cell signaling and proliferation may act in concert with immunomodulation to control inflammation during post-pneumonectomy lung regeneration in adult mice. Experiment Overall Design: For each of the four time points (6 hr, 1 day, 3 day, 7 day), the mice were divided into two groups: (1) pneumonectomy (PNY) and (2) sham operated (SHAM - thoracotomy without lung resection), with eight animals in each group. One microarray was performed on pooled lung tissue from these 8 animals for each time point. Analysis of expression in PNY vs SHAM animals was performed in two ways: using all four microarrays as replicates in a time-independent analysis, as well as analysis of each time point separately (time-dependent) without replicates.

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Management of post-pneumonectomy syndrome using tissue expanders.

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