Showing papers by "Jewish Hospital published in 1996"

Mast cells process bacterial Ags through a phagocytic route for class I MHC presentation to T cells.

Abstract: The pivotal role of mast cells in allergic reactions and inflammatory processes is well established and recent studies have suggested that mast cells may also have a role in specific immune responses. Because mast cells have been shown to phagocytose and kill enterobacteria, we wished to determine whether they could also process bacterial Ags for presentation to T cells. Using a model system in which a well-characterized T cell epitope is expressed within bacteria as a fusion protein, we demonstrate in this paper that mast cells are indeed capable of processing bacterial Ags for presentation through class I MHC molecules to T cell hybridomas after phagocytic uptake of live bacteria. Processing occurs from a number of Gram-negative enterobacteria including Salmonella typhimurium and Escherichia coli. Parallel assays show that processing of the model Ag from enterobacteria by mast cells is similar in efficiency to processing by peritoneal macrophages. Consistent with earlier observations demonstrating a function of the bacterial fimbrial protein FimH in promoting bacterial binding to mast cells, the magnitude of the Ag processing response of E. coli is influenced by bacterial expression of FimH. Taken together, these observations extend the range of cell types capable of the phagocytic pathway of Ag processing and suggest that mast cells may have a previously unrecognized role in the induction of specific immune responses to bacteria.

Association of antithrombotic factor deficiencies and hypofibrinolysis with Legg-Perthes disease.

Abstract: Thirty-three (75 per cent) of forty-four unselected children who had Legg-Perthes disease were found to have coagulation abnormalities. Twenty-three children had thrombophilia (a deficiency in antithrombotic factor C or S, with an increased tendency toward thrombosis); nineteen of the twenty-three children had protein-C deficiency and four had protein-S deficiency. Seven children had a high level (0.25 gram per liter or more) of lipoprotein(a), a thrombogenic, atherogenic lipoprotein associated with osteonecrosis in adults. Three children had hypofibrinolysis (a reduced ability to lyse clots). The mean age of the children when the Legg-Perthes disease was first diagnosed was 5.8 ± 2.7 years, and the mean age at the time of the present study was 10.1 ± 4.4 years. At least one of the first-degree relatives of eleven of the nineteen probands who had a low protein-C level had a low protein-C level as well; all of these low levels represented previously undiagnosed familial protein-C deficiency. The eleven probands who had familial protein-C deficiency were more likely to have early onset of Legg-Perthes disease (at or before the age of five years) than the eleven children who had normal levels of protein C, protein S, and lipoprotein(a) as well as normal fibrinolytic activity (chi-square = 6.6; p = 0.01). At least one first-degree relative of one of the four probands who had a low protein-S level had a low protein-S level and previously undiagnosed familial protein-S deficiency. At least one first-degree relative of six of the seven probands who had a high level of lipoprotein(a) had a familial high level of lipoprotein(a). Six of the seven children who had a high level of lipoprotein(a) also had a low level of stimulated tissue-plasminogen activator activity, the major initiator of fibrinolysis. At least one first-degree relative of one of the three probands who had normal levels of protein C, protein S, and lipoprotein(a) but low stimulated tissue-plasminogen activator activity also had low stimulated tissue-plasminogen activator activity (familial hypofibrinolysis). Legg-Perthes disease, thrombophlebitis, premature myocardial infarction, and stroke, which are ramifications of the familial thrombophilic-hypofibrinolytic disorders, were common in the first and second-degree relatives of the thirty-three children with Legg-Perthes disease who also had thrombophilic-hypofibrinolytic disorders. CLINICAL RELEVANCE: Protein-C or S deficiency, hypofibrinolysis, or a high level of lipoprotein(a) may result in thrombotic venous occlusion of the femur, which leads to the venous hypertension and osteonecrosis of the femoral head characteristic of Legg-Perthes disease. When Legg-Perthes disease develops in a child, the levels of proteins C and S, lipoprotein(a), and stimulated fibrinolysis should be measured. Early diagnosis of protein-C or S deficiency, hypofibrinolysis, or a high level of lipoprotein(a) in such children may open avenues for pharmacological preventive therapy to reduce thrombophilia, stimulate fibrinolysis, or lower the level of lipoprotein(a), potentially ameliorating the Legg-Perthes disease process.

Osteopontin stimulates gelsolin-associated phosphoinositide levels and phosphatidylinositol triphosphate-hydroxyl kinase.

Abstract: Based on previous studies demonstrating activation of phosphatidylinositol 3-hydroxyl kinase (PI3-kinase) and stimulation of a change in cell shape, we examined the effect of osteopontin on the association of phospholipids with gelsolin, an actin-capping/severing protein. Osteopontin stimulated a rapid increase in phosphatidylinositol bisphosphate and phosphatidylinositol triphosphate levels associated with gelsolin in Triton-soluble fractions of cell lysates. The increased levels of phosphatidylinositol triphosphate associated with gelsolin were due to stimulation of PI3-kinase activity associated with gelsolin in the Triton-soluble fractions, and they were blocked by the PI3-kinase inhibitor wortmannin. Osteopontin stimulated translocation of PI3-kinase from the Triton-insoluble to Triton-soluble gelsolin. Osteopontin also decreased Triton-soluble gelsolin/actin complexes consistent with actin uncapping, and increased F-actin levels, which were also blocked by wortmannin. The osteopontin effects were mediated through binding to the alpha(v)beta 3 integrin. Taken together, our studies indicate that osteopontin/alpha(v)beta 3-mediated changes in gelsolin-associated phosphoinositide levels and PI3-kinase activity are related to stimulation of F-actin formation in osteoclasts.

Effect of 21 mg transdermal nicotine patches and smoking cessation on heart rate variability

Abstract: The effect of smoking cessation on cardiac autonomic tone, as reflected by indexes of heart rate variability (HRV), has not been reported. Current smokers (n = 54, mean ± SD age 43 ± 12 years) who desired to quit, and were smoking ≥1 pack/day and had made ≥1 prior attempt at quitting, had 24-hour electrocardiographic recordings. They then attended smoking cessation classes and used transdermal nicotine patches while abstaining from smoking. After 4 to 6 weeks of using 21 mg patches, the 24-hour electrocardiogram was repeated (n = 35). Four weeks after cessation of patch use, the 24-hour electrocardiogram was again recorded in subjects who continued to be abstinent (n = 25). Time and frequency domain measures of HRV based on normal R to R (NN) intervals were computed for all recordings. Smoking cessation significantly decreased heart rate, and increased all 24-hour time and frequency domain indexes of HRV. Part of this change occurred in the transition from smoking to the patch, and further changes occurred with cessation of patch use. For example, the standard deviation of average NN intervals was 114 ± 28 ms at baseline, 121 ± 41 ms with the patch, and 135 ± 26 ms after quitting. At 4 weeks after cessation of all nicotine use, the average heart rate remained higher, and HRV remained lower than values reported for healthy, middle-aged adults.

Risk factors for hepatic veno-occlusive disease following HLA-identical sibling bone marrow transplants for leukemia.

Abstract: The objective was to analyze risk factors for veno-occlusive disease of the liver (VOD) after allogeneic bone marrow transplantation. A cohort of 1717 recipients of HLA-identical sibling transplants for leukemia between 1988 and 1990, in 200 transplant teams worldwide, was studied. Patients were scored as having VOD if liver tissue showed typical histologic features or if they had all three of the following: (1) jaundice; (2) hepatomegaly and right upper quadrant abdominal pain; and (3) ascites and/or unexplained weight gain. Patients surviving more than 7 days post-transplant without histologic or any of these clinical features of VOD were classified as not having VOD. Patient-, disease- and transplant-related characteristics of 95 patients with VOD were compared to those of 1514 without VOD. Variables correlated with an increased risk of VOD were: pretransplant conditioning with busulfan and cyclophosphamide compared to total body radiation (relative risk (RR) 2.8; P 20 years (RR 1.8; P = 0.05). In patients receiving radiation for conditioning, intravenous immune globulin decreased VOD risk (RR 0.26; P = 0.003). This analysis identifies risk factors for VOD. The data suggest several strategies for modifying transplant regimens to reduce VOD risk and which patients might be suitable subjects for trials of strategies of VOD prevention.

Thrombophilia, hypofibrinolysis, and alveolar osteonecrosis of the jaws.

Abstract: Objectives Our specific aim in 49 patients (42 women, 7 men) with osteonecrosis of the jaw was to determine whether thrombophilia (increased tendency to intravascular thrombosis) or hypofibrinolysis (reduced ability to lyse thrombi) were associated with this regional avascular necrosis. Study designs Determinants of thrombosis and fibrinolysis were compared in healthy controls and in 42 women and 7 men who had biopsy-proven idiopathic osteoncrosis of the jaw with severe chronic jaw or facial pain syndromes and failure to respond to conventional medical and dental treatments. Results Of the 49 patients, 35 (71%) had thrombophilia or hypofibrinolysis and only 14 were normal. Thrombophilia as a sole coagulation defect was found in 10 patients, 7 with resistance to activated protein C and 3 with low protein C (deficiency of an antithrombotic protein). Hypofibrinolysis with low stimulated tissue plasminogen activator activity and high lipoprotein (a) (an atherogenic, hypofibrinolytic lipoprotein) were found as sole coagulation defects in seven and eight patients, respectively. Ten patients had mixed defects; 7 of these 10 had thrombophilia with resistance to activated protein C. Sinusoidal dilatation was a constant feature in maxillary and mandibular bone biopsies, suggesting venous occlusion with intramedullary hypertension. Marrow fibrosis and occasional fibrin plugs were additional microscopic features believed to impair venous drainage and to contribute to ischemic necrosis of the alveolar bone. Conclusions Primary thrombophilia and hypofibrinolysis appear to be common, heritable, pathophysiologic risk factors for idiopathic osteonecrosis of the jaws. These coagulation defects may also contribute to alveolar neuralgia, atypical odontalgia and facial neuralgia, idiopathic trigeminal neuralgia, and to treatment failures so often encountered in patients with alveolar osteonecrosis and disabling chronic facial and jawbone pain syndromes.

Risk factors for coronary heart disease among firefighters in Cincinnati.

Abstract: Since 1984, coronary heart disease (CHD) risk factors have been prospectively assessed among Cincinnati firefighters free of CHD at study entry. In total, 806 firemen with a mean age of 37 years at entry have been followed for 6.4 years on average, contributing 5,173 person-years. CHD risk factors were measured every 1-4 years and included weight, blood pressure, cigarette use, fasting glucose, and lipid profile. When, in aggregate, these CHD risk factors were found to be in a high risk range, suggestions were made serially to reduce CHD risk. A composite high CHD risk factor score led to an exercise electrocardiogram (ECG) with thallium scan, which was repeated every 1-4 years. Myocardial infarction (MI) occurred in 7 men, with 1.35 MIs/1,000 man-years; 15 others developed CHD, with 4.25 MI + CHD/1,000 man-years. The firefighters' MI event rate (1.35 MIs/1,000 man-years) was lower (but not significantly, p > 0.1) than that for employed 30- to 39-year-old men free of CHD at entry (2.07/1,000 man years), who had an average follow-up of 5.4 years in the NHANES I study. At study entry, the 22 men who later developed CHD (vs. the 784 who did not develop CHD) were older (p = .0001), smoked more (p = .0001), and were more likely to have first degree relatives with CHD before age 60 (p = .017). After covariance adjusting for age, race, and Quetelet index, men with CHD (vs. those CHD free) had higher systolic and diastolic blood pressures (p = .0001, .0001), higher LDL cholesterol (p = .04), higher total cholesterol (p = .014), and higher triglycerides (p = .03). By Poisson regression, significant independent predictors of CHD events were age (p = .0007), cigarette smoking (p = .001), diastolic blood pressure (p = .056), and family history of CHD at age 0.3). The calculated ratio of savings to cost attributable to the program per year was 5.9/1 ($258,500/$43,600). In the current study, firefighting as an occupation was not associated with increased CHD event rates. CHD events that did develop were, for the most part, associated with modifiable CHD risk factors.

Osteopontin activation of c-src in human melanoma cells requires the cytoplasmic domain of the integrin alpha v-subunit

Abstract: In human melanoma cells, expression of the alpha v beta 3 integrin is correlated with the metastatic potential. The expression of osteopontin (OPN or OP), a protein ligand for the integrin alpha v beta 3, also correlates with metastatic potential of some tumors. Analysis of signal transduction, stimulated by OPN/alpha v beta 3 in human melanoma cells (M21), revealed activation of pp60c-src associated with the integrin. pp60c-src stimulation by OPN was dose dependent, and it was inhibited in vitro by a tyrosine kinase inhibitor, herbimycin-A. To determine the need for the cytoplasmic domain of the alpha v-subunit, in the association of pp60c-src with alpha v beta 3, a cell line expressing truncated alpha v was studied. M21-L cells lacked alpha v expression but stably transfected with complementary DNAs encoding alpha v full length protein alpha v 1018 or alpha v 995 (lacking 23 carboxyl-terminal amino acids), and a fibroblast cell line (FG) expressing alpha v beta 5 but not alpha v beta 3, were used. Western analysis and immune complex kinase assays of anti- alpha v immunoprecipitates demonstrated that M21-L/alpha v995 cells did not exhibit pp60c-src association with alpha v, whereas the alpha v1018 complementary DNA transfected cells and FG cells had pp60c-src associated with the alpha v integrins. Immunofluorescence analysis revealed pp60c-src, alpha v beta 3 integrin, and actin distribution along the plasma membrane of M21 cells. 35S-labeling of cells and analysis of complexes immunoprecipitated by a monoclonal antibody against alpha v beta 3 demonstrated association of actin with the immune complexes. We conclude that OPN stimulates pp60c-src kinase activity associated with the alpha v beta 3 integrin and that the association requires the cytoplasmic tail of the alpha v chain.

Renal interstitial sclerosis in aging: effects of enalapril and nifedipine.

Abstract: The effects of nifedipine and enalapril on age-associated renal interstitial fibrosis were investigated in 60 CF1 female mice. Mice received 20 mg enalapril (ENAL) per L (N = 20), or 40 mg nifedipine (NIF) per L (N = 20) in their drinking water. Control (CONT) mice received tap water ad libitum. The percentages of both interstitial peritubular sclerosis (IPS) in cortex and interstitial medullary sclerosis (IMS) were determined. Kidney tissue was studied using immunological techniques and optical (OM) and electron microscopy (EM) to analyze the expression of renin. alpha-SM-actin and vimentine expression were also evaluated. The results showed that blood pressure levels in ENAL or NIF animals were not different from those of CONT. Renin expression was observed in arcuate vessels (AV) in ENAL animals, whereas no renin staining in AV was found in either NIF or CONT animals. Renin immunoreactivity in the juxtaglomerular apparatus was more intense in ENAL mice, as compared with NIF or CONT animals. Laboratory testing showed the following values: proteinuria (mg/mL): CONT 6.1 +/- 0.6, NIF 11.2 +/- 2.3, and ENAL 1.0 +/- 0.6 (P

HLA-identical sibling bone marrow transplants vs chemotherapy for acute myelogenous leukemia in first remission

Abstract: There is controversy whether adults with acute myelogenous leukemia (AML) in first remission are best treated with chemotherapy or an HLA-identical sibling bone marrow transplant. We studied 1097 adults, 16-50 years old, with AML in first remission. Results of transplants from HLA-identical siblings reported to the International Bone Marrow Transplant Registry (IBMTR; n = 901) were compared with results of chemotherapy in comparable persons treated by the German AML Cooperative Group (GAMLCG; n = 196). Preliminary analyses identified subject- and disease-related variables differing between the cohorts and associated with treatment outcome within each cohort. We adjusted for these variables and differences in time-to-treatment in subsequent comparisons of treatment-related mortality, relapse, survival and leukemia-free survival (LFS). Five-year probability of treatment-related mortality was greater for transplants than chemotherapy (43% (95% confidence interval, 37-49%) vs 7% (3-11%); P< 0.0001). Five-year relapse probability was less for transplants than chemotherapy (24% (20-28%) vs 63% (55-71%); P< 0.0001). Five-year probability of survival was similar with transplants and chemotherapy (48% (43-53%) vs 42% (33-51%); P = 0.24). Five-year LFS probability was higher for transplants than chemotherapy (46% (42-50%) vs 35% (28-41%); P= 0.01). These data indicate that bone marrow transplants from HLA-identical siblings result in comparable survival but greater LFS than chemotherapy in adults with AML in first remission.

Classification of dementia and Alzheimer's disease.

Abstract: Classification of dementia involves the recognition of its presence, followed by the differential diagnosis of its cause. Informant-based methods for dementia detection can be highly sensitive, even when cognitive impairment is mild. Alzheimer's disease (AD) is by far the leading cause of dementia; standardized clinical criteria result in high diagnostic accuracy rates. Classification of other dementing disorders is less satisfactory, particularly because there is frequent clinical and pathological overlap with AD. After AD, the most common causes of dementia are vascular dementia and dementia in persons with Parkinson's disease. Less common dementias include progressive supranuclear palsy, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, and inherited metabolic disorders, most of which are extremely rare. Identifying the cause of dementia is important because some forms can be treated with currently available therapies. In instances involving genetically transmitted disease, genetic testing and counseling of family members may be advisable.

Dietary induction of pancreatic cholesterol esterase : a regulatory cycle for the intestinal absorption of cholesterol

Abstract: Atherosclerosis has a strong dietary basis without a proven molecular mechanism for cholesterol absorption. To investigate the potential role of pancreas in this process and its interaction with the two dietary forms of cholesterol (free and esterified), we undertook to study the role of pancreatic cholesterol esterase in cholesterol absorption. The results showed that (i) cholesterol esters contribute a disproportionately high fraction of absorbed dietary cholesterol, (ii) rates of intestinal cholesterol absorption are related to pancreatic cholesterol esterase activity, (iii) mRNA specific for pancreatic cholesterol esterase is induced 15-fold by dietary sterol esters and 10-fold by free sterol, (iv) the induction of cholesterol esterase mRNA is reversible, and (v) free cholesterol transport into cultured human intestinal cells is enhanced 300% by pancreatic cholesterol esterase. These data implicate pancreatic cholesterol esterase as pivotal in a metabolic loop under positive feedback control for the absorption of dietary cholesterol, whether free or esterified.

Predicting psychiatric length of stay

Abstract: This study sought to determine to what extent a multivariate model could predict psychiatric inpatient length of stay Data were collected from psychiatric service discharges at the Jewish Hospital of Cincinnati during 10 months in 1992 and 1993 Descriptive and multivariate analysis were completed using twelve variables to predict length of stay The results of this investigation indicated a statistically significant relationship between a patient's method of payment and length of stay Specifically, managed care patients were found to have shorter psychiatric inpatient lengths of stay than both private pay and government patients Only within age subgroups were other independent variables predictors of length of stay

Assessing the Progression of Renal Disease

Abstract: Chronic renal insufficiency, once established, tends to progress to end-stage renal failure. The underlying mechanisms have been difficult to elucidate, because the glomerulus and the interstitium have a rather limited repertoire of responses to injury, and the kidney, therefore, responds to a variety of insults in a monotonous fashion. Diverse pathogenetic mechanisms, i.e., vascular, metabolic, or immunologic disorders, may lead to sclerosis, a process in which diverse renal structures are replaced by collagen, fibroblasts and mesenchymal matrix, resulting in disruption of normal renal function (1).

Psychiatric training in medicine residencies : Current needs, practices, and satisfaction

Abstract: The purpose of this study was to determine the current level of psychiatric training in internal medicine residencies, satisfaction with this training, and perceived need, if any, for more training. Surveys were mailed to all training directors of accredited primary care (N = 178) and categorical (N = 410) internal medicine residencies in the United States ; 110 primary care (62%) and 238 categorical (58%) training directors returned the surveys. Seventy-five percent of categorical and 66% of primary care training directors thought their program should spend more time on psychiatric disorders. For all categories of psychiatric disorder, training intensity was greater and satisfaction with training higher in the primary care programs, but less than half of the directors were satisfied with their current level of training, e.g., 33% of categorical and 47% of primary care directors were satisfied with their residents training concerning depression. Training in somatoform disorders, psychotropic drugs, and office psychotherapy were most frequently identified as deficient. The most favored additions to the curriculum were psychiatric consultants in medical clinics and on medical wards. Although most outpatient care for psychiatric disorders is given by primary care physicians, internal medicine training directors perceive current levels of training in their residencies as inadequate. Innovative collaborations between medicine and psychiatry departments will be necessary if treatment of psychiatric disorders in primary care is to be improved.

Prospective optimization of patient selection for emergency cranial computed tomography. univariate and multivariate analyses

Abstract: RATIONALE AND OBJECTIVES To determine if the clinical variables that are important for selecting patients for emergency cranial computed tomography (CT) are population dependent. METHODS Prior to obtaining scans, physicians working in an emergency department in a level II trauma center completed a form describing the indication for the CT examination. These data were matched to the CT scan results and analyzed statistically using univariate and multivariate methods. These results were compared with a prior study at a level I trauma center. RESULTS Of 551 patients having cranial CT, neurologic examination was positive in 340 and CT scan was positive in 122. The neurologic examination correlated strongly with the results of the CT scan (P < 0.00001). In this patient population, the most important clinical predictors of 17 abnormal CT scans from the 211 patients without positive neurologic examinations were seizure and a history of neoplasm. These high-yield variables differ from our prior retrospective study in which intoxication and amnesia were the important predictors in patients with negative examinations. The difference in predictors between the populations most likely results from different prevalences of trauma and ischemic disease. CONCLUSIONS Abnormal neurologic examination is the most important criterion available to select patients for emergency cranial CT. Other variables (eg, seizure, amnesia, intoxication, and history of neoplasm) that help select patients without neurologic findings appear to be population dependent.

Phorbol myristate acetate transactivates the avian β3 integrin gene and induces αvβ3 integrin expression

Abstract: 1,25-Dihydroxyvitamin D3 (1,25(OH)2D3)transactivates the avian beta 3 integrin gene whose promoter contains at least two vitamin D response elements, one of which is in close proximity to a candidate AP1 site (TGACTCA). Since fos/jun and steroid hormones interact to regulate gene expression, we asked whether phorbol-12-myristate-13-acetate (PMA), which stimulates binding of fos/jun to AP1 sites, transactivates the avian beta 3 integrin gene and, if so, does the phorbol ester modulate 1,25(OH)2D3 induction of the gene. We find the candidate AP1 sequence comigrates with the consensus AP1 sequence on electromobility shift assay when incubated with recombinant c-jun protein. Furthermore, PMA prompts expression of beta 3 integrin mRNA in the avian monocytic line, HD11. The increase in message reflects transactivation of the beta 3 gene and is mirrored by plasma membrane appearance of the integrin heterodimer alpha v beta 3. Moreover, attesting to the functional significance of PMA-enhanced alpha v beta 3 expression, cells treated with concentrations of the phorbol ester that induce the beta 3 gene, spread extensively on plastic, an event blocked by an anti-alpha v antibody and a peptide mimetic known to inhibit alpha v beta 3-mediated cell attachment. Interestingly, co-addition of 1,25(OH)2D3 and PMA prompts greater expression of alpha v beta 3 than when the cells are exposed to either agent alone and PMA enhances 1,25(OH)2D3-induced beta 3 integrin mRNA expression. Thus, PMA and 1,25(OH)2D3 impact on the avian beta 3 integrin gene independently and in combination.

Home health care in the continuum: a review.

Abstract: An aging population, financial and technical changes, and consumer preference will drive the increase in the types and volume of service clients receive at home Financial and technical changes will influence the structure of home care services, but home health agencies will continue to partner with primary, acute, and long-term institutional care to provide a continuum of services However, the health care system will need to allocate sufficient resources to home health if it is to serve an increasing number of more frail and unstable clients Lacking such resources, home care may not able to contribute appropriately to the continuum of care, and the effectiveness of the overall health care system may be compromised Challenges to home health agencies' successful operations include decreased resources, changing payment methods, staff shortages, and structural changes in health care systems that fragment care of decrease attention to home health Home health care's traditional goals of serving clients and caregivers directly and educating them toward health and independence can continue if these problems are resolved

A Surgical Approach to Treating Emphysema: Lung Volume Reduction Surgery

Abstract: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in Americans. In addition, COPD significantly affects the quality of life of afflicted patients. Historically, the treatment for emphysema has been primarily medical and includes medications, smoking cessation, and pulmonary rehabilitation. Recently a surgical procedure, lung volume reduction surgery (LVRS) has been reintroduced as a treatment for end-stage lung disease, primarily emphysema. In LVRS, wedge resections are performed to reduce the size of the lungs and improve alveolar functioning. This article describes the evaluation of patients who undergo LVRS and the associated pathophysiology in addition to the surgical procedure, inclusion and exclusion criteria, pre- and postoperative care, potential complications, and preliminary data associated with the procedure at one facility. Although LVRS is not a procedure for all patients with emphysema, it may significantly improve the quality of life of selected patients.