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Single-lung transplantation in emphysema:Retrospective study analyzing survival and waiting list mortality

World Journal of Transplantation 2016年第2期6卷 347-355页

作者： José M Borro María Delgado Elisabeth Coll Salvador Pita Department of Thoracic Surgery and Lung Transplantation Corunna University Hospital Organización Nacional de Trasplantes ONT Clinical Epidemiology Corunna University Hospital

AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung transplantation(SL)(n = 40) or double-lung transplant(DL)(n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization(ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL(P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL(P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival(P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained(n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted(P = 0.875).CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less p

关键词： Lung transplantation Single-lung Survival Complications emphysema Double-lung

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Quantitative Assessment of Air Trapping Using Inspiratory and Expiratory Low-Dose Computed Tomography

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Open Journal of Medical Imaging 2015年第4期5卷 199-203页

作者： Yuki Saito Shin Matsuoka Tsuneo Yamashiro Shoichiro Matsushita Akiyuki Kotoku Kunihiro Yagihashi Hayato Tomita Shingo Sakamoto Shinji Saruya Yasuo Nakajima Department of Radiology St. Marianna University School of Medicine Kawasaki Japan Department of Radiology Graduate School of Medical Science University of the Ryukyus Nishihara Japan

Objective: The purpose of this study was to evaluate the effect of radiation dose reduction on the quantification of air trapping on expiratory CT. Materials and methods: This study was conducted as a retrospective evaluation of inspiratory and expiratory CT studies performed in routine clinical practice before and after alteration of the scanning protocol for expiratory CT at our institute. Eighty-six patients who had a clinical diagnosis of chronic obstructive pulmonary disease (COPD) and underwent inspiratory and expiratory CT and pulmonary function testing (PFT) were included. For the quantitative analysis, CT scans were obtained at six evenly spaced levels from the lung apices to the bases. The area of segmented lung without emphysema between -500 to -950 HU was obtained from the summation of six slices. The relative area between -900 and -950 HU for the area of the segmented lung (RA900-950) was calculated on both the inspiratory and expiratory scans. Comparisons of the RA-change between the standard-dose group (200 mA) and the low-dose group (80 mA) were performed by Mann-Whitney U test. Results: There was no significant difference between the standard-dose group and the low-dose group in the mean RA-change, and RA-change in both the standard-dose and low-dose groups correlated significantly with the results of PFT. In addition, there were no prominent differences in the correlation coefficients between the two groups. Conclusions: Low-dose CT could evaluate air trapping objectively and was not inferior to standard-dose CT for this purpose.

关键词： Chronic Obstructive Pulmonary Disease emphysema Air Trapping Computed Tomography Quantification

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Is tracheostomy suitable for securing airway after facial fi rearm injuries？

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World Journal of Emergency Medicine 2011年第4期2卷 307-309页

作者： Derinoz Oksan Belen F. Burcu Yilmaz Sebahat Department of Pediatrics Medical Faculty of Gazi University Turkey Department of Pediatrics Dr.Sami Ulus Children's Health and Disease Education and Research Hospital Ankara Turkey

BACKGROUND： Head and neck region have many vital structures, and facial fi rearm injuries（FFIs） more likely lead to life-threatening situations than other body injuies. These injuries have highpotential of airway compromise associated with signifi cant morbidity and mortality.METHODS： We describe an 11-year-old boy who had received tracheostomy after a FFIcomplicated with pneumothorax and subcutaneous emphysema 8 hours after the procedure. Thepatient was treated at the Department of Emergency and Critical Care, Gazi University School ofMedicine, Turkey.RESULTS： The patient was discharged without any complications from the Critical Care Unitafter treatment for fi ve days.CONCLUSIONS： Airway management is of utmost importance in resuscitation of FFI, butit is always difficult to secure via the orotracheal route due to the deformed facial structures.Tracheostomy is an option for airway management in FFI affecting head and neck region. However,tracheostomy may be associated with life-threatening complications, which should be closelymonitored with early intervention.

关键词： Airway obstruction emphysema Firearms Pediatrics Tracheostomy

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